{"hospital_name":"Parkview Bryan Hospital","last_updated_on":"2026-01-01","version":"2.2.0","hospital_location":["Parkview Bryan Hospital","Parkview Montpelier Hospital"],"hospital_address":["433 West High Street, Bryan, OH 43506","909 E Snyder Ave, Montpelier, OH 43543"],"license_information":{"license_number":"1293|1294","state":"OH"},"affirmation":{"affirmation":"To the best of its knowledge and belief, the hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date indicated.","confirm_affirmation":true},"financial_aid_policy":["50% off of facility standard gross charges."],"standard_charge_information":[{"description":"BIVALIRUDIN BOLUS FOR CATH LAB (NO CHARGE)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0000-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALANCED SALT SOLN NO.2 IRRIG. IO SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00065-0795-15","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALANCED SALT SOLN NO.2 IRRIG. IO SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00065-0795-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALANCED SALT SOLN NO.2 IRRIG. IO SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00065-1795-04","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCINE UROLOGIC SOLUTION 1.5 % IR SOLN","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"00338-0289-47","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTAMBEN-TETRACAINE-BENZOCAINE 2 %-2 %-14 % (200 MG/SEC) TOP SPRA","drug_information":{"unit":"20","type":"GR"},"code_information":[{"code":"10223-0201-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GRAM TOP OIPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"57896-0145-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GRAM TOP OIPK","drug_information":{"unit":"144","type":"UN"},"code_information":[{"code":"57896-0145-14","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASIRIVIMAB-IMDEVIMAB 60 MG-60 MG/ ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"61755-0039-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN 110 UNIT/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90371","type":"HCPCS"},{"code":"13533-0636-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 1,440 ELISA UNIT/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90632","type":"HCPCS"},{"code":"58160-0826-43","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 1,440 ELISA UNIT/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90632","type":"HCPCS"},{"code":"58160-0826-52","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF)  5 MCG/0.5 ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90744","type":"HCPCS"},{"code":"00006-4981-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF)  5 MCG/0.5 ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90744","type":"HCPCS"},{"code":"00006-4981-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90744","type":"HCPCS"},{"code":"58160-0820-43","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 10 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90744","type":"HCPCS"},{"code":"58160-0820-52","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"58160-0821-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"58160-0821-11","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALEMTUZUMAB 30 MG/ML IV SOLN - NO CHARGE","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"J0202","type":"HCPCS"},{"code":"58468-0357-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE 400 MG IM SERR - NO CHARGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0401","type":"HCPCS"},{"code":"59148-0019-91","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00264-7510-20","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-38","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00409-7922-30","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7922-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7923-36","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7923-37","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP - NO CHARGE","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7070","type":"HCPCS"},{"code":"00990-7922-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASIRIVIMAB-IMDEVIMAB 60 MG-60 MG/ ML IV SOLN Q0240","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q0240","type":"HCPCS"},{"code":"61755-0039-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV CASIRIVIMAB-IMDEVIMAB 1200 MG IVPB CMP","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"09999-9998-29","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV CASIRIVIMAB (REGN10933) 120 MG/ML VIAL","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0024-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV CASIRIVIMAB (REGN10933) 120 MG/ML VIAL","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0026-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASIRIVIMAB-IMDEVIMAB 60 MG-60 MG/ ML IV SOLN Q0244","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0039-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV ELTROMBOPAG OLAMINE (VAYHIT2 STUDY) 12.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00000-0015-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV ELTROMBOPAG OLAMINE (VAYHIT2 STUDY) 25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00000-0016-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV ELTROMBOPAG OLAMINE (VAYHIT2 STUDY) 50 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00000-0017-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PATIENT SUPPLIED MEDICATION","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0043-70","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0062-80","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN (B.BRAUN)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00264-2201-00","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN (B.BRAUN)","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"00264-2201-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % INHL NEBU","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00378-6987-89","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % INHL NEBU","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"00487-9301-33","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00990-6138-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7138-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % (FLUSH) INJ SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"08290-3065-46","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NON-FORMULARY/COMPOUND-ORAL LIQ CUSTOM","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"09999-9900-50","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER NITRATE APPLICATORS 75-25 % TOP STCK","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"12870-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER NITRATE APPLICATORS 75-25 % TOP STCK","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"12870-0001-02","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  2 % MM JELP","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"25021-0673-76","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 15 MG ORAL CPDR","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"55111-0398-90","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0186-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  2 % MM JELP","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"76329-3015-05","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIVIZUMAB 100 MG/ML *PT SUPPLIED* IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90378","type":"HCPCS"},{"code":"60574-4113-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIVIZUMAB 50 MG/0.5 ML *PT SUPPLIED* IM SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90378","type":"HCPCS"},{"code":"60574-4114-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV IMDEVIMAB (REGN10987) 120 MG/ML VIAL","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0025-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV IMDEVIMAB (REGN10987) 120 MG/ML VIAL","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0027-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0000-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE DILUENT - NO CHARGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0036-16","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4888-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS FOR HIPEC - NO CHARGE","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"00409-7972-08","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IRRIGATION (BOLUS)","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"00409-7972-08","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  160 MG ORAL CHEW","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"00904-6645-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6730-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS FOR HIPEC - NO CHARGE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00990-6138-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IRRIGATION (BOLUS)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00990-6138-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV BOLUS FOR HIPEC - NO CHARGE","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7138-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IRRIGATION (BOLUS)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7138-09","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR IRRIGATION, STERILE IR SOLN","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"00990-7973-08","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ULTRASOUND COUPLING MEDIUM TOP GEL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"01707-6035-43","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  325 MG ORAL TAB","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-66","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  650 MG RECT SUPP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"45802-0730-33","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  120 MG RECT SUPP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"45802-0732-33","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50580-0458-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"58394-0018-01","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0186-10","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIROFIBAN 50 MCG/ML BOLUS (NO CHARGE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"25208-0002-03","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOTROVIMAB 500 MG/8 ML (62.5 MG/ML) IV SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"Q0247","type":"HCPCS"},{"code":"00173-0901-86","type":"NDC"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/3 ML (0.083%) INHL NEBU ED PACK","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"00000-0000-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL ELIX (ANY SIZE)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0066-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0137-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL 300 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00378-0181-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-0483-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00406-0484-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-0484-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"A-C-E-ZINC-SOD SELENATE-COPPER 5,000-60-30 UNIT-MG-UNIT ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"00904-7735-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9997-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG TAB PRN PACK FOR H@H","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-66","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE 500 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"16729-0331-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 600 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"54629-4097-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALFUZOSIN 10 MG ORAL TB24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"57237-0114-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 2 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"59762-0066-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0377-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.25 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0377-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0388-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0388-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE 125 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70756-0720-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70756-0721-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 200 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00904-5789-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 400 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"50268-0061-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 400 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"50268-0061-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 800 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"69452-0291-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0059-86","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00245-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMILORIDE 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00574-0292-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-2020-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 500 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-2613-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0419-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0420-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0421-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE  75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0422-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMITRIPTYLINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0423-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0488-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0488-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0496-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0496-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 875 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0015-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE-BENAZEPRIL 2.5-10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0582-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE  2.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"67877-0197-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE-BENAZEPRIL 5-10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0133-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE-BENAZEPRIL 5-20 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0134-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMANTADINE HCL 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68382-0512-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANASTROZOLE 1 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"68001-0155-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN 10 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00378-3950-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN 20 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00378-3951-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN-ACETAMINOPHEN-CAFFEINE 250-250-65 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00536-1326-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN-SOD BICARB-CITRIC ACID 325-1,916-1,000 MG ORAL TBEF","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"01650-0040-19","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID (VITAMIN C)  500 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"08770-1407-41","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN   81 MG ORAL TBEC","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"46122-0598-87","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0684-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN  325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57896-0901-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN  325 MG ORAL TBEC","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57896-0921-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0098-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0099-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE  15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0100-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE  20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0101-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN   81 MG ORAL CHEW","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"63739-0434-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0168-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0170-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 10 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"70710-1285-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70710-1286-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATORVASTATIN 40 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"72205-0024-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE 400 MG IM SERS","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0401","type":"HCPCS"},{"code":"59148-0072-92","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 250 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"68180-0861-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0068-94","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL 10 MG RECT SUPP","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"00574-7050-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00603-2433-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00603-2434-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00603-2435-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0511-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETHANECHOL CHLORIDE 25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0512-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0540-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL  5 MG ORAL TBEC","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00904-6748-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAINE (BULK) 100 % MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"03877-9104-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"B-COMPLEX WITH VITAMIN C ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08068-1154-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAINE (BULK) 100 % MISC POWD","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"09999-9997-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL 10 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9998-69","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISACODYL 10 MG SUPPOSITORY PRN PACK FOR H@H","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9998-69","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 2.5-6.25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"29300-0187-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0336-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG ORAL CHEW","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"46122-0701-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0117-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0577-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENAZEPRIL-HYDROCHLOROTHIAZIDE 20-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0579-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL FUMARATE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0455-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 1,250 MG (500 MG OF CALCIUM)/5 ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0000-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 1,250 MG (500 MG OF CALCIUM)/5 ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00121-4766-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0541-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM POLYCARBOPHIL 625 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00904-2500-91","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 500 MG ORAL CHEW","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"00904-6412-92","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE-VITAMIN D3 600 MG-10 MCG (400 UNIT) ORAL TAB","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"08068-1139-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM ACETATE(PHOSPHAT BIND) 667 MG ORAL CAP","drug_information":{"unit":"200","type":"UN"},"code_information":[{"code":"16571-0813-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL 150 MG ORAL TB24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"16729-0443-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE  5 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"29300-0244-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE 15 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"29300-0477-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL 100 MG ORAL SR12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"31722-0066-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL 150 MG ORAL SR12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"31722-0067-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL 300 MG ORAL TB24","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"42806-0416-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0986-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUSPIRONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0986-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG ORAL TB12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51672-4123-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 10-100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0456-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0661-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0661-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75834-0221-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPECITABINE 150 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"J8520","type":"HCPCS"},{"code":"55111-0496-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 60 MCG/ML SKIN TEST STEP 2","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0039-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 60 MCG/ML SKIN TEST STEP 2","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0039-27","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOXYMETHYLCELLULOSE SODIUM 0.5 % OPHT DPET","drug_information":{"unit":"70","type":"UN"},"code_information":[{"code":"00023-0403-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-3145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 500 MG ORAL CAP","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00093-3147-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 500 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-3196-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-9703-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 60 MCG/ML SKIN TEST STEP 2","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9900-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0978-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0978-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 200 MG ORAL CAP","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"62332-0142-71","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME AXETIL 250 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"65862-0699-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL 12.5 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68001-0151-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL 25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0152-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL  3.125 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0153-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL  6.25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0854-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARVEDILOL  6.25 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0854-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARISOPRODOL 350 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69584-0111-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72241-0023-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN 60 MCG/ML SKIN TEST STEP 2","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"00000-0061-48","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASIRIVIMAB (REGN10933) 120 MG/ML IV SOLN","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0024-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASIRIVIMAB (REGN10933) 120 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0026-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MM MWSH","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0059-27","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE  1 MG/ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0079-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE 1 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0079-32","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3)  400 UNITS ORAL DROP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0116-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CILOSTAZOL 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00093-2064-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CILOSTAZOL  50 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00093-2065-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-3635-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL   5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0158-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPHENIRAMINE MALEATE  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-0012-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3)  400 UNITS ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5823-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITALOPRAM 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6085-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-7243-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 1000 UNITS ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"02055-5033-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3) 125 MCG (5,000 UNIT) ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08068-1131-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 2 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITALOPRAM 40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13668-0011-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE 10 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"24385-0998-75","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0076-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORTHALIDONE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0697-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN HCL 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0243-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"62332-0735-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"62332-0736-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"62332-0737-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBAZAM 2.5 MG/ML ORAL SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0001-71","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 20 MCG/ML NICU ONLY SUSPENSION (ANY SIZE)","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0047-81","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE HCL 0.2 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00228-2128-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN (VITAMIN B-12)  250 MCG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"05026-8853-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN (VITAMIN B-12)  250 MCG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"05026-8853-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COENZYME Q10 100 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"08770-1408-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COENZYME Q10 200 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"08770-1408-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CORTICOTROPIN IM/SC SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLCHICINE 0.6 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"31722-0899-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBAZAM 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42571-0315-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0112-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYPROHEPTADINE 4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0190-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOMIPRAMINE 25 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"51672-4011-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0404-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE  25 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0404-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE HCL 0.1 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68001-0237-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN HCL 150 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0243-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL  75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0536-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL  75 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0536-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOBENZAPRINE 10 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"69097-0846-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONAZEPAM 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72888-0152-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL  60 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-0319-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 125 MCG (0.125 MG) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00143-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 250 MCG (0.25 MG) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00143-1241-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG ORAL CAP","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00527-0586-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0972-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0973-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 20 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00832-6052-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE BOLUS SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-32","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9997-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMETHYLPHENIDATE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"10702-0106-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0113-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0114-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM  2 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0284-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0284-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0285-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0285-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0286-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0286-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64850-0500-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL  30 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68682-0006-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00054-4179-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00054-4179-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00054-4180-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"70954-0403-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYD-DEXAMETH-METOCLOP (BDR) SUP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0042-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-2056-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE-ACETAMINOPHEN 25-500 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"00904-6731-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE CALCIUM 240 MG ORAL CAP","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00904-6997-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-7183-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-7237-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE 25 MG CAPSULE PRN PACK FOR H@H","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9998-64","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 25 MG ORAL CAP","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9998-64","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 120 MG ORAL CP24","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"24979-0026-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DONEPEZIL  5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0275-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 180 MG ORAL CP24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"50742-0249-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60505-0093-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60505-0094-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN 4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60505-0095-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAZOSIN 8 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60505-0096-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DONEPEZIL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0303-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DONEPEZIL 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0303-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 125 MG ORAL TBEC","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0472-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 250 MG ORAL TBEC","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68001-0473-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL  90 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68682-0008-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0910-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOFETILIDE 125 MCG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"72205-0039-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE  50 MG ORAL CAP","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"00143-9802-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6426-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYLAMINE SUCCINATE 25 MG ORAL TAB","drug_information":{"unit":"48","type":"UN"},"code_information":[{"code":"04116-7006-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL IV NICU BOLUS 2 MG/ML FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"09999-9998-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPLERENONE 25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"16729-0293-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"27808-0234-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DUTASTERIDE 0.5 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"31722-0131-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42806-0088-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESCITALOPRAM OXALATE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0282-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL MALEATE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0545-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL MALEATE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0546-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL MALEATE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0547-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL MALEATE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43547-0548-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EZETIMIBE 10 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"59651-0052-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 10 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0494-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULOXETINE 20 MG ORAL CPDR","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0594-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULOXETINE 30 MG ORAL CPDR","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0595-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DULOXETINE 60 MG ORAL CPDR","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0596-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHAMBUTOL 400 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0281-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN  25 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"69238-1170-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERGOCALCIFEROL (VITAMIN D2) 1,250 MCG (50,000 UNIT) ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69452-0151-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"00000-0101-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL S.O.","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"00000-0101-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 75 MG/ML (15 MG IRON/ML) ORAL DROP","drug_information":{"unit":"0.17","type":"ML"},"code_information":[{"code":"00000-0116-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 75 MG/ML (15 MG IRON/ML) ORAL DROP","drug_information":{"unit":"0.33","type":"ML"},"code_information":[{"code":"00000-0116-19","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 75 MG/ML (15 MG IRON/ML) ORAL DROP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"00000-0116-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED  48 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00378-3065-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENOFIBRATE NANOCRYSTALLIZED 145 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00378-3066-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS GLUCONATE 240 MG (27 MG IRON) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6403-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 140 MG (45 MG IRON) ORAL TBER","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"01000-6730-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 325 MG ORAL TBEC","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"06936-7166-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLECAINIDE 20 MG/ML SUSPENSION 100 ML BOTTLE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"09999-9998-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUORESCEIN 1 MG OPHT STRP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"17238-0900-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUORESCEIN 1 MG OPHT STRP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"17238-0900-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0308-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLECAINIDE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0381-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"63739-0645-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FINASTERIDE 5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65862-0149-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0398-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 20 MG ORAL CAP","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0400-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELODIPINE  2.5 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69367-0264-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELODIPINE  5 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69367-0265-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 4 MCG/0.4 ML SYRINGE - NICU STEP 2","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-0036-33","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 1.5 MCG/ML - BUPIVACAINE 0.125% EPIDURAL OR BOLUS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-0099-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"63323-0806-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID-VIT B6-VIT B12 2.5-25-1 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"06936-7222-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID  1 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"11534-0165-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42571-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSINOPRIL 10 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0386-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSINOPRIL 20 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0387-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMFIBROZIL 600 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0224-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMFIBROZIL 600 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0224-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 600 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0507-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 600 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0507-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0580-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 100 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0580-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 300 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0591-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 300 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0591-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUVOXAMINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0159-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 400 MG ORAL CAP","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"65162-0103-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 40 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0194-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 800 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0412-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 20 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"69315-0116-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 40 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"69315-0117-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0118-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"71288-0203-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE MICRONIZED 1.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-8034-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE MICRONIZED 3 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-8035-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 1.25 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"00093-9477-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUANFACINE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-0444-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-0461-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0606-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN (CHILD) RECT SUPP","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"46122-0222-63","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN  200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"54738-0980-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"55111-0321-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIMEPIRIDE 4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"55111-0322-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60505-0141-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE  5 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64980-0280-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE 10 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64980-0281-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE-METFORMIN 1.25-250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0080-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE-METFORMIN 2.5-500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0081-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE-METFORMIN 5-500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0082-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE MICRONIZED 6 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67253-0462-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUANFACINE 1 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70436-0039-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUANFACINE 2 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70436-0040-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72241-0039-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYBURIDE 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72241-0040-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 100 MG/5 ML ORAL SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0094-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0351-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 400 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5853-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-7914-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.375 MG ORAL TB12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"16477-0738-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0129-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE  12.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0130-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE  25 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"31722-0520-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE  50 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"31722-0521-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"31722-0522-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG ORAL TBDL","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42192-0338-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 100 MG ORAL CHEW","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"46122-0632-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE  25 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"51407-0331-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 600 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64380-0808-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 600 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"64380-0808-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE)  1000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"00409-2720-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00093-5060-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL  25 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"23155-0501-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL  50 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"23155-0502-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"64380-0971-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYUREA  500 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"49884-0724-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE PAMOATE  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0177","type":"HCPCS"},{"code":"00185-0674-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODINE STRONG (LUGOLS) 5 % ORAL SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-2775-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0066-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 300 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0071-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 800 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5855-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRBESARTAN 150 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"33342-0048-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRBESARTAN 300 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"33342-0049-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRBESARTAN-HYDROCHLOROTHIAZIDE 150-12.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0330-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRBESARTAN-HYDROCHLOROTHIAZIDE 300-12.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0331-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE  30 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0175-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % INHL SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"60687-0394-79","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % INHL SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"60687-0394-83","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"60687-0405-79","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"60687-0405-83","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDAPAMIDE 1.25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0510-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDAPAMIDE 2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0511-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN  50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0406-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPRAMINE HCL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0133-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPRAMINE HCL 25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0134-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPRAMINE HCL 50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0135-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMDEVIMAB (REGN10987) 120 MG/ML IV SOLN","drug_information":{"unit":"11.1","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0025-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMDEVIMAB (REGN10987) 120 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"61755-0027-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0088-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 25 MG TABLET #7 ED PACK","drug_information":{"unit":"7","type":"UN"},"code_information":[{"code":"00000-0099-96","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTASE 3000 UNITS ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00904-5224-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6351-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTOBACILLUS ACIDOPH-L.BULGAR   1 MILLION CELLS ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"06498-0129-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE   5 MG ORAL TCHD","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"16571-0785-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LETROZOLE 2.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"16729-0034-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"29300-0111-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 100 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"29300-0112-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 150 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"29300-0113-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE  60 MG ORAL TB24","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"59651-0540-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM  500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0657-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM  500 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0657-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 30 MG ORAL CPDR","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68001-0112-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM  500 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0113-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0381-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM  250 MG ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"68001-0402-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE  25 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0965-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE  50 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0966-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE  75 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0967-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 500 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"72578-0099-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARBONATE 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-8526-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARBONATE 300 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-8527-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6797-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 10 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0334-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 20 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0335-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 40 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68001-0486-08","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0518-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0519-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL-HYDROCHLOROTHIAZIDE 20-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0520-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE  88 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0968-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 100 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0969-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 112 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0970-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 125 MCG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68180-0971-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 137 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0972-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 150 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0973-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 175 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0974-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 200 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0975-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 300 MCG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0976-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARBONATE 600 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARBONATE 300 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0223-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CARBONATE 450 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0224-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOXAPINE SUCCINATE  5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1394-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0872-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00555-0873-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.5 MG ORAL TAB NO DOSE CHECK","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.5 MG TAB (H@H ONLY)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6007-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6008-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6009-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM OXIDE 400 MG (241.3 MG MAGNESIUM) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"01000-6700-28","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CHLORIDE 64 MG ORAL TBEC","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"05789-6635-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LYSINE  500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"07985-4600-55","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM (ATIVAN) 0.5 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"09999-9998-35","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MECLIZINE 25 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"16571-0661-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN  25 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"31722-0700-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN  50 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"31722-0701-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOSARTAN-HYDROCHLOROTHIAZIDE 50-12.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0423-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 2 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0691-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURASIDONE  20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0494-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURASIDONE  40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0495-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOVASTATIN 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0315-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 1 MG ORAL TAB NO DOSE CHECK","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0905-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG ORAL TAB NO DOSE CHECK","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0906-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MECLIZINE 12.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8597","type":"HCPCS"},{"code":"00536-1297-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG/ML ORAL CONC","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0052-83","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-0710-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL  5 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00093-2204-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00115-1802-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN  850 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"00378-7186-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-1142-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN  500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-7162-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN  5 MG ORAL TBDL","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"04746-9058-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN 5 MG ORAL TAB S.O.","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"04746-9058-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN  5 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"08068-1040-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN 5 MG ORAL TAB S.O.","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"08068-1040-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELATONIN 5MG TAB PRN PACK FOR H@H","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9998-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHIMAZOLE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0070-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE  5 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"33342-0297-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59762-0056-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN 1000 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0162-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MELOXICAM  7.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68382-0050-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METFORMIN  500 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70010-0491-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL  500 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"70010-0754-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL  750 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"70010-0770-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"68001-0557-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00555-0606-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL 40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00555-0607-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL - SMOG RECTAL ENEMA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0041-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL ORAL OIL (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0041-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL ORAL OIL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0116-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-2203-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE BOLUS SYRINGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9900-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOXIDIL  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0256-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0526-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 250 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0526-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0265-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0265-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0266-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0266-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0267-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62584-0267-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 500 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68001-0365-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL SUCCINATE  25 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72516-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL SUCCINATE  50 MG ORAL TB24","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"72516-0031-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL SUCCINATE 100 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72516-0032-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOLAZONE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72888-0052-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDODRINE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"82293-0004-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 0.2 MG/0.4 ML SYRINGE - NICU STEP 2","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00000-0083-44","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0040-91","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 25 MCG TABLET (QUARTER TAB)","drug_information":{"unit":"0.025","type":"ME"},"code_information":[{"code":"00000-0101-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 50 MCG TABLET (HALF TAB)","drug_information":{"unit":"0.05","type":"ME"},"code_information":[{"code":"00000-0101-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN, STRESS FORMULA ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00904-0262-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN WITH FOLIC ACID 400 MCG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-0530-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVITAMIN-IRON-FOLIC ACID 18-400 MG-MCG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"02055-5004-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 15 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"13107-0031-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NATEGLINIDE  60 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"16571-0758-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NATEGLINIDE 120 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"16571-0759-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST  4 MG ORAL CHEW","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"31722-0727-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST 10 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"33342-0102-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOXIDIL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0257-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST  5 MG ORAL CHEW","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"57237-0213-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0120-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0120-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0188-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0190-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NADOLOL  20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69097-0867-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MODAFINIL 100 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"69452-0342-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"00093-7334-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"64380-0725-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 180 MG ORAL TBEC","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"16729-0261-29","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN 1000 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00536-7038-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN  500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-2272-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN  250 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"01000-6700-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN  100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08068-1057-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE  5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0068-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEBIVOLOL  2.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"43547-0524-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEBIVOLOL  5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0525-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEBIVOLOL 10 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43547-0526-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"45802-0143-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5-400-5,000 MG-UNIT-UNIT TOP OIPK","drug_information":{"unit":"144","type":"UN"},"code_information":[{"code":"45802-0143-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE (POLACRILEX) 2 MG BUCL GUM","drug_information":{"unit":"110","type":"UN"},"code_information":[{"code":"46122-0724-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIACIN  500 MG ORAL TB24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"47335-0539-81","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 30 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE  2.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0163-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROFURANTOIN MACROCRYSTAL  50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0390-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 90 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0756-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 60 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0758-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORTRIPTYLINE 10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75907-0069-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORTRIPTYLINE 25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75907-0070-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORTRIPTYLINE 50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75907-0071-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORTRIPTYLINE 75 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75907-0072-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 2 MG/ML SUSPENSION REPACK","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0084-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEGA-3 ACID ETHYL ESTERS 1 G ORAL CAP","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"42806-0552-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE  7.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"43598-0165-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"43598-0166-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0644-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB (H@H)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0644-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0644-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB (H@H)","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0644-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 15 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0167-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0168-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE  5 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0371-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE 10 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0372-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 150 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0137-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0138-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 10 MG ORAL CPDR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0395-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 20 MG ORAL CPDR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0396-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLMESARTAN  5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68462-0436-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLMESARTAN 20 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68462-0437-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLMESARTAN 40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68462-0438-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL  4 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"57237-0075-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL  8 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"57237-0076-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MV NO.189-FERROUS SULFATE 11 MG IRON/ML ORAL DROP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"00000-0116-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN VK 0.5 MG/ML FOR ORAL DESENSITIZATION - ANY SIZE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0666-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN VS 5 MG/ML FOR ORAL DESENSITIZATION - ANY SIZE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0666-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE-COCOA BUTTER 0.25-88.44 % RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"00536-1186-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOXIFYLLINE 400 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5448-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1)  100 MCG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"01184-5779-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MV NO.226-FERROUS SULFATE 18 MG IRON ORAL CHEW","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"01650-0599-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.42 ORAL CHEW","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08068-1049-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 MG ORAL TAB","drug_information":{"unit":"18","type":"UN"},"code_information":[{"code":"24385-0603-89","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57237-0041-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG ORAL TBEC","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"60687-0736-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG ORAL TBEC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0736-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENAZOPYRIDINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0681-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENAZOPYRIDINE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0682-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0175-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG ORAL TBEC","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"68084-0813-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG ORAL TBEC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0813-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68382-0097-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 20 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68382-0098-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 30 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68382-0099-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"64980-0290-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAVASTATIN 20 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00093-7201-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAVASTATIN 40 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00093-7202-98","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE  8 MEQ ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00245-5315-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE  8 MEQ ORAL TBER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00245-5315-89","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00245-5319-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00245-5319-89","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIMIDONE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1301-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRENATAL VIT NO.130-IRON-FOLIC 27 MG IRON- 800 MCG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5313-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYSACCHARIDE IRON COMPLEX 150 MG IRON ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-5395-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIPEXOLE 0.125 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"13668-0091-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIPEXOLE 0.25 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"13668-0092-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIPEXOLE 0.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"13668-0093-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAMIPEXOLE 1 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"13668-0094-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIOGLITAZONE 15 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0054-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIOGLITAZONE 30 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"33342-0055-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIOGLITAZONE 45 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0056-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRASUGREL 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60505-4643-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ ORAL TBTQ","drug_information":{"unit":"80","type":"UN"},"code_information":[{"code":"68084-0360-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAZOSIN 2 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70010-0085-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRAZOSIN 1 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70756-0429-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 10 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"00054-0017-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 5 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"00054-8724-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"00603-5336-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"59746-0171-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 20 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"59746-0175-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0122-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0122-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0134-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0134-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 20 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 20 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"60687-0145-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"70954-0061-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG TABLET #3 ED PACK","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"00000-0045-39","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE-PHENYLEPH-CODEINE 6.25-5-10 MG/5 ML ORAL SYRP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0054-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5 ML ORAL SYRP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0094-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE-CODEINE 6.25-10 MG/5 ML ORAL SYRP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0107-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIMIDONE 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1231-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  60 MG ORAL CS24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-4116-37","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  80 MG ORAL CS24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-4117-37","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 120 MG ORAL CS24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-4118-37","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHEDRINE HCL  60 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6728-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOXINE (VITAMIN B6)  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"01000-6700-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHEDRINE HCL  30 MG ORAL TAB","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"46122-0428-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 150 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0230-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 225 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0231-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROGESTERONE MICRONIZED 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0807-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0242-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0446-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-2077-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-2078-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-2079-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-2081-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0169","type":"HCPCS"},{"code":"68001-0162-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE  50 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"16729-0132-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RANOLAZINE  500 MG ORAL TB12","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"27241-0125-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   1 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43547-0341-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   2 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"43547-0342-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   3 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43547-0343-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 200 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"50228-0382-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 300 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"50228-0383-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL  1.25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0474-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0670-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0671-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REPAGLINIDE 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0672-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RALOXIFENE 60 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0709-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0246-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 300 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"67877-0247-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 400 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0248-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0184-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL  2.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0429-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL  5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0430-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMIPRIL 10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0431-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 150 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0599-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 0.25 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68382-0112-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0095-34","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES-DOCUSATE SODIUM 8.6-50 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00536-1248-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES  8.6 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00904-7252-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN  5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"27808-0155-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROSUVASTATIN 10 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"27808-0156-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 0.5 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43547-0340-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE  80 MG ORAL CHEW","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57896-0791-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0210-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE 0.25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0030-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0032-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPINIROLE  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0033-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 3 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"62332-0064-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 800 MG ORAL TAB","drug_information":{"unit":"270","type":"UN"},"code_information":[{"code":"65162-0058-27","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SERTRALINE  25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0011-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SERTRALINE 100 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"65862-0013-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN  5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65862-0050-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SERTRALINE  50 MG ORAL TAB","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"68180-0352-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 10 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0478-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 20 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0479-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 125 MG ORAL CHEW","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"69618-0032-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"72241-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOTALOL 120 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-1060-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOTALOL  80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-1061-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00223-1720-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 1000 MG MISC TBSO","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00223-1760-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 650 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00536-1047-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD PHOS DI, MONO-K PHOS MONO 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"03932-8107-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE,DIBASIC ANHYDROUS POWDER","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"05155-2044-76","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAMOXIFEN 10 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"59651-0299-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0426-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFASALAZINE 500 MG ORAL TBEC","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59762-0104-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFASALAZINE 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59762-5000-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMVASTATIN 40 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0210-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0614-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 800-160 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0614-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"63323-0186-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0419-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAMSULOSIN 0.4 MG ORAL CAP","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"68382-0132-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TELMISARTAN 20 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68382-0471-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TELMISARTAN 20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68382-0471-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TELMISARTAN 40 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68382-0472-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 1 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"16729-0042-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 0.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7507","type":"HCPCS"},{"code":"55111-0525-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM 15 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00228-2076-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"07733-3934-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE MONONITRATE (VIT B1) 100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"07733-3934-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0872-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0874-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE  20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"31722-0531-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBINAFINE HCL 250 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51991-0526-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIZANIDINE 2 MG ORAL TAB","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"55111-0179-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERAZOSIN  1 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59746-0383-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERAZOSIN  2 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59746-0384-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERAZOSIN  5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59746-0385-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIZANIDINE 4 MG ORAL TAB","drug_information":{"unit":"150","type":"UN"},"code_information":[{"code":"60505-0252-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0795-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0795-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORSEMIDE   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0125-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM 30 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67877-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TELMISARTAN 80 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"67877-0484-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL  50 MG ORAL TAB (H@H)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0808-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE  25 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68382-0138-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68382-0140-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TELMISARTAN 40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68382-0472-78","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN-HYDROCHLOROTHIAZIDE 80-12.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00378-6321-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN-HYDROCHLOROTHIAZIDE 160-12.5 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00378-6322-77","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIHEXYPHENIDYL 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-5335-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9998-71","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE 50 MG TAB PRN PACK FOR H@H","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9998-71","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE 150 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"42291-0829-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50111-0561-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL-ACETAMINOPHEN 37.5-325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"53746-0617-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN  80 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"55111-0732-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0443-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAZODONE  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0443-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE  37.5 MG ORAL CP24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65862-0527-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0157-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0327-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMTERENE-HYDROCHLOROTHIAZID 75-50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0328-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL  50 MG ORAL TAB (H@H)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0808-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANDOLAPRIL 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0566-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANDOLAPRIL 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0567-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIHEXYPHENIDYL 5 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"70954-0211-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMTERENE-HYDROCHLOROTHIAZID 37.5-25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72578-0090-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN B COMPLEX ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00536-1378-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL  80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-0343-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL  40 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-0404-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN A 10000 UNITS ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-2085-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMINS A,C,E-ZINC-COPPER 2,148 MCG-113 MG-45 MG-17.4MG ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"08068-1052-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN E (DL, ACETATE) 90 MG (200 UNIT) ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08770-1407-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"08770-1407-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 120 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0486-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57237-0176-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0761-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0762-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0763-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  3 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0764-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0765-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0766-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN  7.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0768-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE  75 MG ORAL CP24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65862-0528-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE 150 MG ORAL CP24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65862-0697-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE  37.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0158-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VENLAFAXINE  75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0160-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 180 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75834-0158-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 0.5 MG TABLET (HALF TAB)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0076-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 1.25 MG TABLET (HALF TAB)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0076-53","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 1.5 MG TABLET (HALF TAB)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0076-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 3.75 MG TABLET (HALF TAB)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0076-55","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 2.5 MG TABLET (DYE FREE QTR TAB)","drug_information":{"unit":"2.5","type":"ME"},"code_information":[{"code":"00000-0080-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 5 MG TABLET (DYE FREE HALF TAB)","drug_information":{"unit":"5","type":"ME"},"code_information":[{"code":"00000-0080-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 70-HYPROMELLOSE (PF) 0.1-0.3 % OPHT DPET","drug_information":{"unit":"36","type":"UN"},"code_information":[{"code":"00065-8063-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC SULFATE 50 MG ZINC (220 MG) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"05789-6865-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC SULFATE 50 MG ZINC (220 MG) ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"07733-3983-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC SULFATE 50 MG ZINC (220 MG) ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"07733-3983-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 150 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"31722-0814-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLPIDEM  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0838-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLPIDEM  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0838-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FEBUXOSTAT 80 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0191-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WARFARIN 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65162-0769-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLPIDEM 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0160-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 500-125 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"65862-0502-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.01,"discounted_cash":0.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME AXETIL 500 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"65862-0700-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZONISAMIDE  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0242-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZONISAMIDE 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0244-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.0,"discounted_cash":0.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITRIOL 0.25 MCG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"64380-0723-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN POLISTIREX 30 MG/5 ML ORAL SU12","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0094-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 50 MG/ML SUSPENSION 120 ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0116-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORZOXAZONE 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-2520-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  7 % INHL NEBU","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"08349-0307-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 96 % (W/W) ORAL SUSR 176 G BTL","drug_information":{"unit":"176","type":"GR"},"code_information":[{"code":"32909-0750-03","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0579-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 G ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0695-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 1 G ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0695-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.04,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FEBUXOSTAT 40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0190-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOMIPRAMINE 75 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0409-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN  600 MG ORAL TA12","drug_information":{"unit":"500","type":"UN"},"code_information":[{"code":"63824-0008-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0692-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.05,"discounted_cash":0.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0382-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0354-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5 MG ORAL TAB (H@H)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0354-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0354-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5 MG ORAL TAB (H@H)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0354-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHAMBUTOL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68180-0280-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 750 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"72578-0100-92","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOLAZONE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"76385-0137-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.06,"discounted_cash":0.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"59762-0075-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.02,"discounted_cash":0.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE  5 MG/5 ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0040-32","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML ORAL CONC","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0060-51","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM HYDROX-MAGNESIUM CARB 95-358 MG/15 ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0086-44","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG ORAL CHEW","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-2268-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 500 MG ORAL TBEC","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-7124-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 500 MG ORAL TBEC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00832-7124-89","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"07135-1010-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM, SODIUM PHOSPHATES 280-160-250 MG ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"07135-1010-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9900-56","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESEVELAM 625 MG ORAL TAB","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"27808-0190-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0427-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.11,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0184-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEMANTINE 10 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"60687-0184-57","type":"NDC"}],"standard_charges":[{"gross_charge":1.09,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG ORAL TAB (H@H)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0579-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0579-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG ORAL TAB (H@H)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0579-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0590-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  4 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0590-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE  4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0423-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE  4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0423-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":0.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON  4 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"57237-0077-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.08,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE MALEATE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0164","type":"HCPCS"},{"code":"60219-2039-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.07,"discounted_cash":0.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  1 MG/ML ORAL LIQD","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0000-14","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 0.1 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0073-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0078-05","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0101-56","type":"NDC"}],"standard_charges":[{"gross_charge":1.12,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0257-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-60 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-0485-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.18,"discounted_cash":0.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00406-5755-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-5755-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 160 MG ORAL CS24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-4119-37","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 250 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00781-1961-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5 MG-3 MG(2.5 MG BASE)/3 ML INHL NEBU","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9998-67","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 500000 UNITS ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0051-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.2,"discounted_cash":0.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALACYCLOVIR  500 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"31722-0704-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.17,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0565-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0565-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALSALAZIDE 750 MG ORAL CAP","drug_information":{"unit":"280","type":"UN"},"code_information":[{"code":"60505-2575-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.15,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE   2 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"65162-0896-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.14,"discounted_cash":0.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 300 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0383-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 240 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.16,"discounted_cash":0.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN  50 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"69238-1171-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE  1.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"70954-0401-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.13,"discounted_cash":0.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE 50 MG CAPSULE #10 ED PACK","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"00000-0031-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 500 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00781-1962-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 2.5 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49483-0221-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONAZEPAM 1 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0174-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONAZEPAM 1 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0174-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEXILETINE 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0239-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE-CLIDINIUM 5-2.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60219-1677-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0396-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB (H@H ONLY)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0396-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0396-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB (H@H ONLY)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0396-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPRAZOLAM 0.5 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"65862-0454-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPYLTHIOURACIL 50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"67253-0651-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.25,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUETIAPINE 400 MG ORAL TB24","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0602-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0214-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 100 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0214-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.23,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE  60 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68382-0659-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.21,"discounted_cash":0.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYCHLOROQUINE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-1544-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE SODIUM 360 MG ORAL TBEC","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"J7518","type":"HCPCS"},{"code":"67877-0427-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.22,"discounted_cash":0.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BICALUTAMIDE 50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"47335-0485-88","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON  8 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"68001-0247-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON  8 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"68001-0247-17","type":"NDC"}],"standard_charges":[{"gross_charge":1.24,"discounted_cash":0.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD (ANY-SIZE)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0000-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE-TETRACAINE (LET) SOLN 1 ML","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0036-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.37,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVIT-MIN-FERROUS GLUCONATE  9 MG IRON/15 ML ORAL LIQD","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0106-52","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQD","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0116-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL  5 MG ORAL TAB","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"00378-0327-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00409-4282-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1313-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 200 MG ORAL TAB","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-68","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 200 MG PRN PACK FOR H@H","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-68","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 300 MG ORAL CP24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"24979-0029-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0362-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDROCORTISONE 0.1 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0330-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOFETILIDE 250 MCG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"59651-0119-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.26,"discounted_cash":0.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURASIDONE  60 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0496-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL  75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0308-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NADOLOL  40 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"69238-1124-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.33,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE HCL  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-1679-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.35,"discounted_cash":0.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0211-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN, PORCINE (PF)   10 UNITS/ML IV SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"06425-3222-35","type":"NDC"}],"standard_charges":[{"gross_charge":1.28,"discounted_cash":0.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN, PORCINE (PF)  10 UNIT/ML IV SYRG NICU TPN ONLY NO DOSE WARNING","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"08881-5801-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.32,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"23155-0547-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"23155-0547-42","type":"NDC"}],"standard_charges":[{"gross_charge":1.34,"discounted_cash":0.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE  4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0175","type":"HCPCS"},{"code":"64980-0291-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.3,"discounted_cash":0.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLAVOXATE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00574-0115-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL  32.4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6575-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYLANTA-DIPHEN-LIDO (MDL) 10 ML PODS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"09999-9997-59","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDROCORTISONE 0.1 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0330-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESIPRAMINE  75 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0115-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 200 MG ORAL TB12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51672-4124-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.4,"discounted_cash":0.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 30 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"57237-0012-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.39,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMETHYLPHENIDATE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"57664-0379-88","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0473-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  25 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0473-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0484-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  50 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0484-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  75 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0495-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN  75 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0495-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0506-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREGABALIN 100 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0506-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.44,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0082-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0082-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.41,"discounted_cash":0.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 100 MCG ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"70954-0443-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.38,"discounted_cash":0.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED  25 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"00093-9018-19","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED  25 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"00093-9018-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.42,"discounted_cash":0.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"Q0161","type":"HCPCS"},{"code":"62332-0738-31","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  10 MG/5 ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0039-46","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOBENZAPRINE 10 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0045-42","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 500 MG CAPSULE #4 ED PACK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00000-0063-36","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 875-125 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-1852-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 2 MG ORAL CAP","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 2MG CAPSULE PRN PACK FOR H@H","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"09999-9998-65","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAXOLOL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"10702-0013-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE-CA CARB-MAG HYDROX 10-800-165 MG ORAL CHEW","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"16837-0246-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMCICLOVIR 500 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0026-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN  40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0062-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.52,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 6.5 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49483-0222-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM BICARB-CITRIC ACID 25 MEQ ORAL TBEF","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"51801-0001-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRTAZAPINE 15 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"57237-0011-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.46,"discounted_cash":0.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"URSODIOL 300 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0421-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURASIDONE  80 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0497-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.48,"discounted_cash":0.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHEDRINE-GUAIFENESIN 60-600 MG ORAL TB12","drug_information":{"unit":"36","type":"UN"},"code_information":[{"code":"63824-0057-36","type":"NDC"}],"standard_charges":[{"gross_charge":1.53,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINOCYCLINE 100 MG ORAL CAP","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"65862-0211-50","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE  4 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"65862-0458-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPROPION HCL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0309-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.55,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE HCL 40 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0451-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":0.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL-CHLORTHALIDONE 50-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70710-1167-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.51,"discounted_cash":0.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOLAZONE 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"72888-0054-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.5,"discounted_cash":0.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO-HC-TCN-DIPHEN-NYSTAT (MARY'S MAGIC W/LIDOCAINE)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00001-0004-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.64,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0214-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.59,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/0.5 ML INHL NEBU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00487-9901-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE  10 MG MM TROC","drug_information":{"unit":"70","type":"UN"},"code_information":[{"code":"00574-0107-70","type":"NDC"}],"standard_charges":[{"gross_charge":1.65,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG ORAL CHEW","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-3854-61","type":"NDC"}],"standard_charges":[{"gross_charge":1.6,"discounted_cash":0.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOMIPRAMINE 50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"27241-0211-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALSARTAN 160 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"33342-0064-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.56,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIOTHYRONINE  5 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"42794-0018-12","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN  10 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0436-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN  10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0436-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  25 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0566-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0566-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-IBUPROFEN 7.5-200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"53746-0145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.66,"discounted_cash":0.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE  5 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64850-0510-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.57,"discounted_cash":0.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0373-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0083-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 20 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0083-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 4 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70710-1062-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.63,"discounted_cash":0.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL-CHLORTHALIDONE 100-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70710-1168-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.61,"discounted_cash":0.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  50 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00000-0159-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPECITABINE 500 MG ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"J8521","type":"HCPCS"},{"code":"55111-0497-04","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":0.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLN","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"00000-0042-99","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTON-HYDROCHLOROTHIAZ 25-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0403-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00406-0124-23","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-0124-62","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM (ATIVAN) 0.5 MG/ML SUSPENSION 20 ML BOTTLE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"09999-9998-34","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMIVUDINE 150 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"33342-0001-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.77,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESVENLAFAXINE SUCCINATE  50 MG ORAL TB24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"51991-0311-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.76,"discounted_cash":0.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 240 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0217-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 240 MG ORAL CP24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0217-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0418-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0418-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENTACAPONE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0654-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIZATRIPTAN  5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"67877-0261-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIZATRIPTAN  5 MG ORAL TAB","drug_information":{"unit":"18","type":"UN"},"code_information":[{"code":"67877-0261-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE HCL 60 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0452-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.68,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE DINITRATE 30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0562-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.74,"discounted_cash":0.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 225 MG ORAL CP12","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68462-0408-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NADOLOL  80 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69097-0869-07","type":"NDC"}],"standard_charges":[{"gross_charge":1.72,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 30-600 MG ORAL TB12","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"72288-0219-49","type":"NDC"}],"standard_charges":[{"gross_charge":1.69,"discounted_cash":0.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROID (PORK)  15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"75834-0310-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.7,"discounted_cash":0.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CINACALCET 30 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J0604","type":"HCPCS"},{"code":"69097-0410-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.71,"discounted_cash":0.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOXACILLIN 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-3123-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDESARTAN 16 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-3231-93","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.2 MG/HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9104-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.2 MG/HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-9104-93","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4887-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"27241-0161-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE  60 % (W/V) ORAL SUSP  355 ML BTL","drug_information":{"unit":"355","type":"ML"},"code_information":[{"code":"32909-0187-02","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSYLLIUM HUSK (ASPARTAME) 3.4 G ORAL PWPK","drug_information":{"unit":"44","type":"UN"},"code_information":[{"code":"37000-0024-44","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 5-6.25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"42799-0921-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISOPROLOL-HYDROCHLOROTHIAZIDE 10-6.25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"42799-0922-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.81,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0807-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL  25 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0807-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIZATRIPTAN 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"67877-0262-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIZATRIPTAN 10 MG ORAL TAB","drug_information":{"unit":"18","type":"UN"},"code_information":[{"code":"67877-0262-18","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 0.1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0574-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 3 MG ORAL CECX","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68382-0720-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE HCL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-1681-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 25 MG ORAL TB24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"72241-0030-22","type":"NDC"}],"standard_charges":[{"gross_charge":1.8,"discounted_cash":0.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4 MG/ML INJ *FOR ORAL USE ONLY*","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4 MG/ML INJ *FOR ORAL USE ONLY* (ANY SIZE)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML (5 ML) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4 MG/ML INJ *FOR ORAL USE ONLY*","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4 MG/ML INJ *FOR ORAL USE ONLY* (ANY SIZE)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML (5 ML) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-54","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":0.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"72266-0118-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 30 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"72266-0118-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.79,"discounted_cash":0.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZATHIOPRINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7500","type":"HCPCS"},{"code":"68084-0229-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZATHIOPRINE  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7500","type":"HCPCS"},{"code":"68084-0229-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.78,"discounted_cash":0.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 25 MG TABLET #10 ED PACK","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"00000-0045-40","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSORBIDE MONONITRATE  20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00228-2620-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACAMPROSATE 333 MG ORAL TBEC","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"00378-6333-80","type":"NDC"}],"standard_charges":[{"gross_charge":1.91,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  20 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-1473-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.83,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE SULFATE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-8958-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIFLUOPERAZINE  2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-8032-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROGEN PEROXIDE  3 % MISC SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00869-4706-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM AND SODIUM PHOSPHATE - NICU","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"06025-8006-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM AND SODIUM PHOSPHATE - NICU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"06025-8006-15","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 100 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"43386-0480-24","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ ORAL CPER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0671-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ ORAL CPER","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"50268-0671-13","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL  10 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0375-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORDIAZEPOXIDE HCL  10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0375-20","type":"NDC"}],"standard_charges":[{"gross_charge":1.84,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE HCL 20 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"55111-0256-60","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORICONAZOLE  50 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68462-0572-30","type":"NDC"}],"standard_charges":[{"gross_charge":1.9,"discounted_cash":0.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN  75 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"69238-1172-09","type":"NDC"}],"standard_charges":[{"gross_charge":1.85,"discounted_cash":0.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  60 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-2080-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEFLUNOMIDE  10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"70748-0129-06","type":"NDC"}],"standard_charges":[{"gross_charge":1.87,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (4 ML) INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00143-9156-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (4 ML) INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00143-9156-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00143-9156-10","type":"NDC"}],"standard_charges":[{"gross_charge":1.86,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE PF 400 MCG/0.1ML INTRAVITREAL SOLUTION REPACK","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"09999-9997-84","type":"NDC"}],"standard_charges":[{"gross_charge":1.88,"discounted_cash":0.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9102-16","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.1 MG/HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-9102-93","type":"NDC"}],"standard_charges":[{"gross_charge":1.93,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACCHAROMYCES BOULARDII 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00414-2000-32","type":"NDC"}],"standard_charges":[{"gross_charge":1.92,"discounted_cash":0.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROBENECID 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-5347-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA-ENTACAPONE 31.25-125-200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-5641-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"37000-0023-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.02,"discounted_cash":1.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE  4 % TOP PTMD","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"46122-0450-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.97,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESVENLAFAXINE SUCCINATE 100 MG ORAL TB24","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"51991-0312-90","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0428-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 12.5 MG ORAL TB24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60505-1316-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILDENAFIL (PULM.HYPERTENSION) 20 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0788-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILDENAFIL (PULM.HYPERTENSION) 20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0788-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.98,"discounted_cash":0.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 50-200 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0282-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA 50-200 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0282-11","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORETHINDRONE ACETATE 5 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"68462-0304-50","type":"NDC"}],"standard_charges":[{"gross_charge":2.0,"discounted_cash":1.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE HCL  1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-1678-01","type":"NDC"}],"standard_charges":[{"gross_charge":1.96,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"00641-0376-21","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1200","type":"HCPCS"},{"code":"00641-0376-25","type":"NDC"}],"standard_charges":[{"gross_charge":1.95,"discounted_cash":0.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2305-17","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-22","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0064-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.01,"discounted_cash":1.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0433-00","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE (PF) 20 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0433-22","type":"NDC"}],"standard_charges":[{"gross_charge":1.94,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN (BULK) 100 % MISC LIQD","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0043-36","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN 100% - SMOG RECTAL ENEMA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0043-36","type":"NDC"}],"standard_charges":[{"gross_charge":2.04,"discounted_cash":1.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDESARTAN 32 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-3232-93","type":"NDC"}],"standard_charges":[{"gross_charge":2.07,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE HCL 80 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00781-2168-60","type":"NDC"}],"standard_charges":[{"gross_charge":2.18,"discounted_cash":1.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-0542-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TADALAFIL (PULM. HYPERTENSION) 20 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"33342-0278-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.19,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROID (PORK)  30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42192-0329-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIOTHYRONINE 25 MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"42794-0019-12","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0646-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0646-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.12,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHENAMINE HIPPURATE 1 G ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0142-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0567-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0567-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.13,"discounted_cash":1.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 400 MG ORAL TB12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51672-4125-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOMOXETINE  10 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0519-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROFURANTOIN MONOHYD/M-CRYST 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0606-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.1,"discounted_cash":1.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE  1 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0014-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00143-9858-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00143-9858-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 250 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7337-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 250 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7337-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN, PORCINE (PF)  100 UNITS/ML IV SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"06425-3333-35","type":"NDC"}],"standard_charges":[{"gross_charge":2.08,"discounted_cash":1.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 50 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"09999-9999-46","type":"NDC"}],"standard_charges":[{"gross_charge":2.16,"discounted_cash":1.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-1778-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOPROLOL TARTRATE 5 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-1778-15","type":"NDC"}],"standard_charges":[{"gross_charge":2.14,"discounted_cash":1.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"00000-0062-64","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAMADOL 50 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0102-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.31,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR  6 MG/ML ORAL SUSR","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0107-69","type":"NDC"}],"standard_charges":[{"gross_charge":2.34,"discounted_cash":1.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METAXALONE 800 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1435-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA-ENTACAPONE 18.75-75-200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-5625-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN-DIPYRIDAMOLE 25-200 MG ORAL CM12","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43598-0339-60","type":"NDC"}],"standard_charges":[{"gross_charge":2.26,"discounted_cash":1.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 G ORAL PWPK","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"46122-0014-52","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUININE SULFATE 324 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"50742-0238-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":1.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEXILETINE 250 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0241-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.33,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  325 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51672-2116-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  325 MG RECT SUPP","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"51672-2116-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE SYRINGE FOR PLEURODESIS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0186-PH","type":"NDC"}],"standard_charges":[{"gross_charge":2.32,"discounted_cash":1.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0186-PH","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"64380-0173-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64380-0173-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.21,"discounted_cash":1.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 300 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68001-0362-06","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  15 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0157-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  15 MG ORAL TBER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0157-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.29,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM   5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69315-0184-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.27,"discounted_cash":1.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9262-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9262-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9924-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.24,"discounted_cash":1.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9112-16","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG/HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-9112-93","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIFLUOPERAZINE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-8034-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.38,"discounted_cash":1.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00832-1550-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.43,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML ORAL LIQD 2 ML POD","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"09999-9997-09","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  18 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13811-0706-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL  50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"27241-0162-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 9 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49483-0223-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE 100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0580-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIORIDAZINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0580-20","type":"NDC"}],"standard_charges":[{"gross_charge":2.44,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOCONAZOLE 200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51672-4026-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.4,"discounted_cash":1.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 200 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62559-0993-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.46,"discounted_cash":1.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 125 MG ORAL CDRS","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0313-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 125 MG ORAL CDRS","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0313-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 400 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0380-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.36,"discounted_cash":1.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PINDOLOL  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"76385-0131-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.51,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 250 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3402-95","type":"NDC"}],"standard_charges":[{"gross_charge":2.45,"discounted_cash":1.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF)  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00641-6151-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00641-6151-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF)  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00641-6151-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.5,"discounted_cash":1.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML SYRINGE - NICU","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"36000-0283-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.47,"discounted_cash":1.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4713-32","type":"NDC"}],"standard_charges":[{"gross_charge":2.41,"discounted_cash":1.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 0.2 MG/0.4 ML SYRINGE - NICU STEP 2","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"09999-9999-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.53,"discounted_cash":1.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 1 MG TABLET #15 ED PACK","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"00000-0046-42","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0099-95","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  3 % INHL NEBU","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00378-6997-89","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 10 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-8952-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBIDOPA-LEVODOPA-ENTACAPONE 50-200-200 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00781-5669-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.58,"discounted_cash":1.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON ASPGLY,PS-C-B12-FA-CA-SUC 150-60-25-1 MG-MG-MCG-MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"05199-1798-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENTHOL MM LOZG S.O.","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"08041-0000-42","type":"NDC"}],"standard_charges":[{"gross_charge":2.64,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  27 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13811-0707-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.61,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROID (PORK)  60 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42192-0330-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 0.5 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49884-0311-52","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 0.5 MG ORAL TBDL","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"49884-0311-91","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN   80 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51672-2114-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN   80 MG RECT SUPP","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"51672-2114-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0415-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOZAPINE 100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0415-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.59,"discounted_cash":1.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 0.2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68001-0575-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 250 MG ORAL TB24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0310-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 250 MG ORAL TB24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.62,"discounted_cash":1.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 0.3 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"09999-9999-86","type":"NDC"}],"standard_charges":[{"gross_charge":2.6,"discounted_cash":1.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN, PORCINE (PF)   10 UNITS/ML IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"08881-5801-21","type":"NDC"}],"standard_charges":[{"gross_charge":2.56,"discounted_cash":1.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (2 ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00409-6102-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (2 ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00409-6102-19","type":"NDC"}],"standard_charges":[{"gross_charge":2.54,"discounted_cash":1.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-0235-24","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  15 MG ORAL TAB (H@H)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-0235-24","type":"NDC"}],"standard_charges":[{"gross_charge":2.65,"discounted_cash":1.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTALBITAL-ACETAMINOP-CAF-COD 50-325-40-30 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-3000-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.76,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIZATIDINE 300 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00185-0300-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-1134-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE-AMPHETAMINE 20 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-8954-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.73,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.65 % NASL SPRA","drug_information":{"unit":"44","type":"ML"},"code_information":[{"code":"00904-3865-75","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":1.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANAGRELIDE 0.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13668-0453-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  36 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13811-0708-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.72,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMTRICITABINE-TENOFOVIR (TDF) 200-300 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"42385-0953-30","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE BIT 2 %-1:100,000 INJ CRTG","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"50227-1030-05","type":"NDC"}],"standard_charges":[{"gross_charge":2.85,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROBENECID-COLCHICINE 500-0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0263-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.75,"discounted_cash":1.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MISOPROSTOL 200 MCG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"59762-5008-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.81,"discounted_cash":1.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE  5 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"64380-0172-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE  5 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64380-0172-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.78,"discounted_cash":1.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 50 MG/ML IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"00143-9875-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 50 MG/ML IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"00143-9875-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.67,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00143-9857-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00143-9857-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 15 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"00338-0069-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL (PF) 4 MG/2 ML INJ SOLN","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"09999-9998-62","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":1.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9999-62","type":"NDC"}],"standard_charges":[{"gross_charge":2.84,"discounted_cash":1.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7923-36","type":"NDC"}],"standard_charges":[{"gross_charge":2.8,"discounted_cash":1.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 4 MG ORAL TAB (IP TAPER)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00054-4184-25","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBAZAM 2.5 MG/ML ORAL SUSP","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00000-0001-83","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 20 MCG/ML NICU SUSPENSION","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0047-80","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CODEINE SULFATE 30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-0244-24","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUBIPROSTONE 24 MCG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00254-3029-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.95,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.6 MG/HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9116-16","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.6 MG/HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-9116-93","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOXAPINE SUCCINATE 25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1396-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.0,"discounted_cash":1.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON FUM,AG-C-B12-FA-CA-SUCC 151-60-10-1 MG-MG-MCG-MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"05199-1544-90","type":"NDC"}],"standard_charges":[{"gross_charge":2.87,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  54 MG ORAL TR24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"13811-0709-10","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLESTYRAMINE (WITH SUGAR) 4 G ORAL PWPK","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"42806-0266-95","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLESTYRAMINE (WITH SUGAR) 4 G ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"42806-0266-98","type":"NDC"}],"standard_charges":[{"gross_charge":2.94,"discounted_cash":1.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 G ORAL PWPK","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"42806-0270-95","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLESTYRAMINE-ASPARTAME 4 G ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"42806-0270-98","type":"NDC"}],"standard_charges":[{"gross_charge":2.89,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 160 MG/5 ML ORAL SUSP","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"50580-0579-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.88,"discounted_cash":1.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP LIPK - STERILE","drug_information":{"unit":"22.5","type":"ML"},"code_information":[{"code":"65517-0035-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.97,"discounted_cash":1.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 45 MG ORAL CAP","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"68180-0676-11","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3407-78","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3407-95","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"63323-0474-00","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1630","type":"HCPCS"},{"code":"63323-0474-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.91,"discounted_cash":1.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"63323-0751-03","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"71288-0807-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2371","type":"HCPCS"},{"code":"71288-0807-02","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL  5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"00703-4502-01","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL  5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"00703-4502-04","type":"NDC"}],"standard_charges":[{"gross_charge":2.99,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE   5 MG ORAL CAP","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"J8700","type":"HCPCS"},{"code":"67877-0537-14","type":"NDC"}],"standard_charges":[{"gross_charge":2.86,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN 10 MG/ML ORAL LIQUID (COMPOUNDED)","drug_information":{"unit":"16.2","type":"ML"},"code_information":[{"code":"00000-0000-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.5 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0107-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.22,"discounted_cash":1.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUBIPROSTONE  8 MCG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00254-3028-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALICYLIC ACID 40 % TOP PTMD","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"05332-9410-59","type":"NDC"}],"standard_charges":[{"gross_charge":3.23,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 700 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"10361-0778-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARENICLINE 0.5 MG ORAL TAB","drug_information":{"unit":"56","type":"UN"},"code_information":[{"code":"27241-0173-56","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABACAVIR 300 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"31722-0557-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.16,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 500 MG ORAL TB24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0260-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIVALPROEX 500 MG ORAL TB24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"50268-0260-13","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP LIPK - STERILE","drug_information":{"unit":"22.5","type":"ML"},"code_information":[{"code":"52380-0001-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE 16 MG ORAL C24P","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0745-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP SOLN","drug_information":{"unit":"14.8","type":"ML"},"code_information":[{"code":"67618-0150-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.01,"discounted_cash":1.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 75 MG ORAL CAP","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"68180-0677-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.04,"discounted_cash":1.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOEXIPRIL  7.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0209-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.18,"discounted_cash":1.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPSONE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0135-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE HCL 5 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"72319-0006-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 60 MG/2 ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"63323-0162-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 60 MG/2 ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1885","type":"HCPCS"},{"code":"63323-0162-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.17,"discounted_cash":1.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE  8 MG ORAL TAB","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"68001-0558-55","type":"NDC"}],"standard_charges":[{"gross_charge":3.07,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON  4 MG ORAL TBDL","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"09999-9998-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.24,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV CASIRIVIMAB-IMDEVIMAB 600 MG IVPB","drug_information":{"unit":"55","type":"ML"},"code_information":[{"code":"Q0244","type":"HCPCS"},{"code":"09999-9998-31","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0350-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 % ORAL LIQD (UD)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0000-57","type":"NDC"}],"standard_charges":[{"gross_charge":3.24,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIFLUNISAL 500 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00093-9222-06","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00143-9594-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1318-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEXILETINE 200 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-4108-37","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INV SOTROVIMAB (EUA) 500 MG/50 ML CMP","drug_information":{"unit":"58","type":"ML"},"code_information":[{"code":"09999-9998-36","type":"NDC"}],"standard_charges":[{"gross_charge":3.25,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD BICARB-CITRIC AC-SIMETH 2.21-1.53 GRAM/4 GRAM ORAL GREP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"10361-0793-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.39,"discounted_cash":1.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 3 MG ORAL TR24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"27808-0223-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":1.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZAFIRLUKAST 20 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"31722-0008-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.47,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMELTEON 8 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42571-0375-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.46,"discounted_cash":1.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARICALCITOL 1 MCG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"49483-0687-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.4,"discounted_cash":1.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARENICLINE 1 MG ORAL TAB","drug_information":{"unit":"56","type":"UN"},"code_information":[{"code":"49884-0156-76","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2-0.1037 -0.0194 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50742-0667-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.36,"discounted_cash":1.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 50 MG ORAL CHEW","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0156-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE  2.5 MG ORAL TR24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0768-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLIPIZIDE  2.5 MG ORAL TR24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0768-21","type":"NDC"}],"standard_charges":[{"gross_charge":3.49,"discounted_cash":1.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACEBUTOLOL 400 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0256-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALANTAMINE  8 MG ORAL C24P","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0744-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.5,"discounted_cash":1.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR 30 MG ORAL CAP","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"68180-0675-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.3,"discounted_cash":1.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOEXIPRIL 15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0208-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.43,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0167-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.44,"discounted_cash":1.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON 4 MG ODT #3 ED PACK","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"00000-0102-00","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMETHYLPHENIDATE  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00078-0381-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 120 MG ORAL C24P","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-6320-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALTREXONE 50 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-1170-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.59,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) RESPIRATORY","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00409-4282-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) RESPIRATORY","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00409-4282-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.58,"discounted_cash":1.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00409-4887-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE 14 MG/24 HR TD PT24","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"46122-0352-74","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE 21 MG/24 HR TD PT24","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"46122-0353-74","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICOTINE  7 MG/24 HR TD PT24","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"46122-0354-74","type":"NDC"}],"standard_charges":[{"gross_charge":3.61,"discounted_cash":1.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMIDE PEROXIDE  6.5 % OTIC DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"46122-0557-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.6,"discounted_cash":1.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   2 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49884-0401-52","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   2 MG ORAL TBDL","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"49884-0401-91","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN - 5 ML FOR CHARGE PANELS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"55150-0165-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 50 MG ORAL CHEW","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0156-95","type":"NDC"}],"standard_charges":[{"gross_charge":3.52,"discounted_cash":1.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESTIPOL 1 G ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"62559-0395-12","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 325 MG ORAL CP12","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"69680-0131-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.67,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1165","type":"HCPCS"},{"code":"00641-0493-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":1.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN 10 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"63323-0012-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN 10 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2590","type":"HCPCS"},{"code":"63323-0012-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":1.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"71288-0303-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYANOCOBALAMIN (VITAMIN B-12) 1000 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3420","type":"HCPCS"},{"code":"71288-0303-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.54,"discounted_cash":1.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE  6 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"70954-0404-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOFLURANE  99.9 % INHL LIQD","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"00000-0009-86","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0101-99","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-1177-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOXACILLIN 500 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-3125-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5 ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00121-0431-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRAHYDROZOLINE 0.05 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00536-1217-94","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BROMOCRIPTINE 2.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00574-0106-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYCHLOROQUINE 25 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"32","type":"ML"},"code_information":[{"code":"09999-9992-83","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"09999-9997-07","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM HYDROXIDE 400 MG/5ML - SMOG RECTAL ENEMA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9997-22","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % TOP CREA","drug_information":{"unit":"28.4","type":"GR"},"code_information":[{"code":"24385-0021-03","type":"NDC"}],"standard_charges":[{"gross_charge":3.75,"discounted_cash":1.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOMOXETINE  25 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0528-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLN","drug_information":{"unit":"10.15","type":"ML"},"code_information":[{"code":"81033-0002-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 325 MG/10.15 ML ORAL SOLN","drug_information":{"unit":"10.15","type":"ML"},"code_information":[{"code":"81033-0002-40","type":"NDC"}],"standard_charges":[{"gross_charge":3.74,"discounted_cash":1.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0169-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (10 ML) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00409-6102-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML (10 ML) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00409-6102-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.8,"discounted_cash":1.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2308-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM (PF) 5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2308-22","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE 0.2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J2765","type":"HCPCS"},{"code":"09999-9999-42","type":"NDC"}],"standard_charges":[{"gross_charge":3.7,"discounted_cash":1.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"63323-0965-05","type":"NDC"}],"standard_charges":[{"gross_charge":3.72,"discounted_cash":1.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON 4MG ODT PRN PACK FOR H@H","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"09999-9998-61","type":"NDC"}],"standard_charges":[{"gross_charge":3.68,"discounted_cash":1.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"00000-0061-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL LIQD","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"24385-0379-26","type":"NDC"}],"standard_charges":[{"gross_charge":3.78,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 10 MG/ML SUSPENSION 30 ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0037-24","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 10 MG/ML SUSPENSION 30 ML (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0040-43","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 180 MG ORAL C24P","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-2882-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 6 MG ORAL TR24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"27808-0224-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.85,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN  125 MG ORAL CAP","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"42494-0450-20","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYMETAZOLINE 0.05 % NASL SPRY","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"46122-0165-10","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE  50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0363-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACEBUTOLOL 200 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0050-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACEBUTOLOL 200 MG ORAL CAP","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"50268-0050-15","type":"NDC"}],"standard_charges":[{"gross_charge":3.87,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTALBITAL-ACETAMINOPHEN-CAFF 50-325-40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"50268-0553-13","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOMOXETINE  18 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0520-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOMOXETINE  60 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0522-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG ORAL CM12","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"60505-2805-07","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":1.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP LIPK - STERILE","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"65517-0035-02","type":"NDC"}],"standard_charges":[{"gross_charge":3.96,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  30 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0158-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  30 MG ORAL TBER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0158-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.97,"discounted_cash":1.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPAFENONE 425 MG ORAL CP12","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"68462-0410-60","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":1.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIAGABINE  4 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"72205-0085-30","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4276-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.84,"discounted_cash":1.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJ SOLN NO DOSE CHECK","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6044-01","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJ SOLN NO DOSE CHECK","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6044-25","type":"NDC"}],"standard_charges":[{"gross_charge":3.88,"discounted_cash":1.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MERCAPTOPURINE 50 MG ORAL TAB","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00054-4581-11","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":1.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 20 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0040-29","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0086-04","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNITS/ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00121-0868-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELECTROLYTE-R IN DEXTROSE 5 % 5 % IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00409-7968-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPIRIN  300 MG RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"00574-7034-12","type":"NDC"}],"standard_charges":[{"gross_charge":4.02,"discounted_cash":2.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCOSE 4 G ORAL CHEW","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"08770-1426-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCOSE 4 G ORAL CHEW (FOR GLUCOMMANDER)","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"08770-1426-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL (DUONEB) PRN PACK FOR H@H","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9998-67","type":"NDC"}],"standard_charges":[{"gross_charge":4.13,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROXIDOPA 100 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"31722-0014-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNITS/ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0800-17","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNITS/ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0800-40","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":2.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VILAZODONE 40 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0234-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.15,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FELBAMATE 600 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62559-0731-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.03,"discounted_cash":2.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 15 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"64380-0174-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 15 MG ORAL TBDL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64380-0174-02","type":"NDC"}],"standard_charges":[{"gross_charge":4.18,"discounted_cash":2.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMMONIA AROMATIC 15 % (W/V) INHL SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"67777-0251-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68084-0728-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0728-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":2.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"55150-0177-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.1,"discounted_cash":2.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV FLEX CONTAINER 500 ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"09999-9999-07","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5%-0.3 % SOD.CHLORIDE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7925-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"NOHCPCS","type":"HCPCS"},{"code":"00990-7984-36","type":"NDC"}],"standard_charges":[{"gross_charge":4.0,"discounted_cash":2.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 150 MG CAPSULE #8 ED PACK","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"00000-0063-35","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0067-58","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DISOPYRAMIDE PHOSPHATE 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00093-3129-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATES 19-7 GRAM/118 ML RECT ENEM","drug_information":{"unit":"133","type":"ML"},"code_information":[{"code":"00132-0201-40","type":"NDC"}],"standard_charges":[{"gross_charge":4.26,"discounted_cash":2.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE-AMITRIPTYLINE 2-10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0330-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.3,"discounted_cash":2.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM  50 MG/5 ML ORAL LIQD","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00904-7279-66","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM  50 MG/5 ML ORAL LIQD","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00904-7279-72","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTOBACILLUS ACIDOPH-L.BULGAR 100 MILLION CELLS ORAL GRPK","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"06498-0146-12","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTOBACILLUS ACIDOPH-L.BULGAR 100 MILLION CELLS ORAL GRPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"06498-0146-98","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"27241-0163-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.34,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 150 MG ORAL TAB","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"57237-0005-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.2,"discounted_cash":2.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL  12.5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0304-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL  12.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0304-21","type":"NDC"}],"standard_charges":[{"gross_charge":4.37,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE INJ SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"64253-0020-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.36,"discounted_cash":2.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ITRACONAZOLE 100 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"67877-0454-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.39,"discounted_cash":2.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0823-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68084-0823-21","type":"NDC"}],"standard_charges":[{"gross_charge":4.19,"discounted_cash":2.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE  5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0016-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.23,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-3365-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-3365-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.32,"discounted_cash":2.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 2 MG/ML SYRINGE - NICU","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"09999-9991-13","type":"NDC"}],"standard_charges":[{"gross_charge":4.24,"discounted_cash":2.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE  4 MG ORAL TAB (IP DOSEPAK)","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"00603-4593-21","type":"NDC"}],"standard_charges":[{"gross_charge":4.27,"discounted_cash":2.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  30 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00054-0236-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEFAZODONE 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00093-1024-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.44,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIZATIDINE 150 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00185-0150-60","type":"NDC"}],"standard_charges":[{"gross_charge":4.49,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 240 MG ORAL C24P","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-6440-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROAMPHETAMINE SULFATE  5 MG ORAL CPER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-8960-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.62,"discounted_cash":2.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % VIAL - NO CHARGE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00409-4888-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.4,"discounted_cash":2.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 20 % TOP OINT","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"00536-1316-28","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE ACETATE 25 MG RECT SUPP","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"00713-0503-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":2.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODINE-POTASSIUM IODIDE 5-10 % TOP SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"09999-9997-48","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODINE-POTASSIUM IODIDE 5-10 % TOP SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"10481-0111-08","type":"NDC"}],"standard_charges":[{"gross_charge":4.61,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC 500 UNIT/GRAM TOP OINT","drug_information":{"unit":"28.4","type":"GR"},"code_information":[{"code":"24385-0060-03","type":"NDC"}],"standard_charges":[{"gross_charge":4.55,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 1.5 MG ORAL TR24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"27808-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE 9 MG ORAL TR24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"27808-0225-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.56,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROID (PORK) 120 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42192-0328-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.5,"discounted_cash":2.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOMOXETINE  40 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"55111-0521-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORETHINDRONE AC-ETH ESTRADIOL 1-5 MG-MCG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0828-09","type":"NDC"}],"standard_charges":[{"gross_charge":4.6,"discounted_cash":2.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOS (PF) 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"63323-0506-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.63,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN, PORCINE (PF)   10 UNITS/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1642","type":"HCPCS"},{"code":"06332-3557-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"55150-0255-20","type":"NDC"}],"standard_charges":[{"gross_charge":4.48,"discounted_cash":2.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 16 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"J7509","type":"HCPCS"},{"code":"68001-0559-69","type":"NDC"}],"standard_charges":[{"gross_charge":4.59,"discounted_cash":2.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"09999-9900-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SYRINGE - PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"09999-9900-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SYRINGE FOR ECTOPIC PREGNANCY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"09999-9900-24","type":"NDC"}],"standard_charges":[{"gross_charge":4.57,"discounted_cash":2.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHIMAZOLE 3 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00000-0000-74","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 600 MG TABLET #20 ED PACK","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"00000-0029-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 20 MG/ML ORAL CONC","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0072-51","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 2 % TD OINT","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"00281-0326-08","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE-AMITRIPTYLINE 4-10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0042-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALINE SYRINGE FOR PLEURODESIS","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00409-0488-PH","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL 70 % MISC SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"04628-7500-30","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":2.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 % TOP OINT","drug_information":{"unit":"28.4","type":"GR"},"code_information":[{"code":"24385-0276-03","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDESARTAN  4 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0114-07","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 200 MG ORAL CM12","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"60505-2806-07","type":"NDC"}],"standard_charges":[{"gross_charge":4.73,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE  50 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0676-11","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE  50 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"60687-0676-57","type":"NDC"}],"standard_charges":[{"gross_charge":4.81,"discounted_cash":2.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 300 MG ORAL TB12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62332-0025-31","type":"NDC"}],"standard_charges":[{"gross_charge":4.84,"discounted_cash":2.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM CITRATE ORAL SOLN","drug_information":{"unit":"296","type":"ML"},"code_information":[{"code":"69452-0389-98","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":2.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9923-90","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJ SOLN - 1 ML FOR CHARGE PANELS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"00781-3825-71","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJ SOLN - 1 ML FOR CHARGE PANELS","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"00781-3825-96","type":"NDC"}],"standard_charges":[{"gross_charge":4.72,"discounted_cash":2.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1940","type":"HCPCS"},{"code":"00409-6102-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.64,"discounted_cash":2.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 1 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2587-04","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 1 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2587-05","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 1 MG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"00143-9746-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 1 MG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3105","type":"HCPCS"},{"code":"00143-9746-10","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 50 MG/ML EYE DROPS (COMPOUNDED)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"00000-0000-27","type":"NDC"}],"standard_charges":[{"gross_charge":4.68,"discounted_cash":2.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"00000-0065-63","type":"NDC"}],"standard_charges":[{"gross_charge":4.66,"discounted_cash":2.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 0.2 MG/ML ORAL SOLUTION 40 ML","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"00000-0000-06","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 0.2 MG/ML ORAL SOLUTION 40 ML (ANY SIZE)","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"00000-0000-07","type":"NDC"}],"standard_charges":[{"gross_charge":4.96,"discounted_cash":2.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 125 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0040-99","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 20 GRAM/30 ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00121-1154-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 20 GRAM/30 ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00121-1154-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATES 9.5-3.5 GRAM/59 ML RECT ENEM","drug_information":{"unit":"66","type":"ML"},"code_information":[{"code":"00132-0202-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  20 MG ORAL MP30","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-1820-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.14,"discounted_cash":2.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00990-7985-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ULTRASOUND GEL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"06114-0001-08","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZONATATE 100MG CAPSULE PRN PACK FOR H@H","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"09999-9998-63","type":"NDC"}],"standard_charges":[{"gross_charge":4.92,"discounted_cash":2.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"21922-0063-04","type":"NDC"}],"standard_charges":[{"gross_charge":4.98,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  1 % NASL SPRY","drug_information":{"unit":"29.6","type":"ML"},"code_information":[{"code":"46122-0689-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.1,"discounted_cash":2.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0364-01","type":"NDC"}],"standard_charges":[{"gross_charge":4.9,"discounted_cash":2.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"63323-0626-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":2.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"65862-0107-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.03,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE HCL  5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69238-1680-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.06,"discounted_cash":2.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM (PF) 1 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"00409-2305-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.02,"discounted_cash":2.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 0.1 MG/ML SYRINGE - NICU STEP 2","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"09999-9997-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.12,"discounted_cash":2.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"63323-0306-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 40 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"63323-0306-02","type":"NDC"}],"standard_charges":[{"gross_charge":5.19,"discounted_cash":2.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML ORAL SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00000-0000-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00000-0060-98","type":"NDC"}],"standard_charges":[{"gross_charge":5.04,"discounted_cash":2.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP FOR PIGGYBACKS","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"NOHCPCS","type":"HCPCS"},{"code":"00990-7984-36","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 300-30 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0066-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5 ML SOLN 60 ML ED PACK","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0076-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0101-74","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN SODIUM EXTENDED  30 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00071-3740-66","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":2.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PINDOLOL 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0127-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE-AMITRIPTYLINE 2-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0442-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.47,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  10 MG ORAL MP30","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-1810-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.26,"discounted_cash":2.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANAZOL 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1368-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.48,"discounted_cash":2.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 250-125 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00781-1874-31","type":"NDC"}],"standard_charges":[{"gross_charge":5.24,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE (BULK) 100 % MISC CRYS","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"00869-0602-43","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% CHEST TUBE FLUSH","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9903-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.2,"discounted_cash":2.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYLANTA-DIPHEN-LIDO (MDL) LIQUID (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9912-34","type":"NDC"}],"standard_charges":[{"gross_charge":5.28,"discounted_cash":2.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE  98 % ORAL SUSR 340 ML BTL","drug_information":{"unit":"340","type":"ML"},"code_information":[{"code":"32909-0764-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.44,"discounted_cash":2.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEG 400-HYPROMELLOSE-GLYCERIN 1-0.2-0.2 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"57896-0181-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEG 400-HYPROMELLOSE-GLYCERIN 1-0.2-0.2 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"57896-0184-05","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 300 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"60687-0586-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 300 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0586-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.42,"discounted_cash":2.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-BACITRACNZN-POLYMYXNB 3.5MG-400 UNIT- 5,000 UNIT/GRAM TOP OINT","drug_information":{"unit":"14.2","type":"GR"},"code_information":[{"code":"68001-0483-46","type":"NDC"}],"standard_charges":[{"gross_charge":5.23,"discounted_cash":2.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 100 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"09999-9999-78","type":"NDC"}],"standard_charges":[{"gross_charge":5.36,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 4 MCG/0.4 ML SYRINGE - NICU STEP 2","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"09999-9991-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.4,"discounted_cash":2.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 10 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"09999-9999-16","type":"NDC"}],"standard_charges":[{"gross_charge":5.22,"discounted_cash":2.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CITRATE 60 MG/ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0101-81","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":2.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APIXABAN 2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00003-0893-31","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APIXABAN 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00003-0894-31","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQD","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00121-1488-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQD","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00121-1488-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00406-0522-23","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE-ACETAMINOPHEN 7.5-325 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-0522-62","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD-POT-MAG-CAL-CHLO-ACE-GLUC 25-40.6-5 MEQ/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00517-3120-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE  9.5 MG/24 HOUR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00781-7309-31","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE  9.5 MG/24 HOUR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00781-7309-58","type":"NDC"}],"standard_charges":[{"gross_charge":5.54,"discounted_cash":2.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL  1.4 % MM SPRA","drug_information":{"unit":"177","type":"ML"},"code_information":[{"code":"46122-0748-76","type":"NDC"}],"standard_charges":[{"gross_charge":5.67,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1%) RESPIRATORY","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"55150-0159-74","type":"NDC"}],"standard_charges":[{"gross_charge":5.56,"discounted_cash":2.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VILAZODONE 20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0233-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.53,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARUNAVIR 600 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"69097-0248-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.51,"discounted_cash":2.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE-NALOXONE 2-0.5 MG SL SUBL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0572","type":"HCPCS"},{"code":"60687-0626-11","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE-NALOXONE 2-0.5 MG SL SUBL","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"J0572","type":"HCPCS"},{"code":"60687-0626-65","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE  4 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE  4 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"67457-0422-54","type":"NDC"}],"standard_charges":[{"gross_charge":5.5,"discounted_cash":2.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE IN 5 % DEXTROSE 80 MG/50 ML (1,600 MCG/ML) INFUSION SYRINGE - NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"09999-9991-41","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9722-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 5 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9722-24","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9722-24","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 5 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"09999-9999-49","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 1 GRAM/100 ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"00338-1709-40","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-38","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-48","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7923-37","type":"NDC"}],"standard_charges":[{"gross_charge":5.6,"discounted_cash":2.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE  25 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J8530","type":"HCPCS"},{"code":"62332-0618-31","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":2.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CITRATED 10 MG/ML ORAL LIQUID","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0066-32","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN 800 MG TABLET #10 ED PACK","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"00000-0087-58","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERPHENAZINE-AMITRIPTYLINE 4-25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-0574-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.96,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CITRATED 10 MG/ML ORAL LIQUID (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9900-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARIFENACIN  7.5 MG ORAL TB24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"16571-0767-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.74,"discounted_cash":2.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORTHALIDONE  25 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"51079-0058-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORTHALIDONE  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0058-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.72,"discounted_cash":2.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE (BULK) 100 % MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"51552-0200-05","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"63323-0186-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITONAVIR 100 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0687-30","type":"NDC"}],"standard_charges":[{"gross_charge":5.92,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIMODIPINE 30 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"69452-0209-07","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIMODIPINE 30 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"69452-0209-20","type":"NDC"}],"standard_charges":[{"gross_charge":5.84,"discounted_cash":2.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3404-85","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3404-95","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00409-1165-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE *PF* SYRINGE FOR EYE SURGERY","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00409-1165-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":2.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00009-0870-26","type":"NDC"}],"standard_charges":[{"gross_charge":5.91,"discounted_cash":2.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.4 MG/ML IV SYRINGE - FROM STOCK SOLUTION NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1100","type":"HCPCS"},{"code":"09999-9999-68","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  2 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1890-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1890-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  2 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1890-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 4 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 4 MG/ML INJECTION S.O. - RESPIRATORY USE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 4 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 4 MG/ML INJECTION S.O. - RESPIRATORY USE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1891-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-01","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML IV SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 10 MG/ML RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1893-03","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"63323-0452-00","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76045-0004-10","type":"NDC"}],"standard_charges":[{"gross_charge":5.8,"discounted_cash":2.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-25","type":"NDC"}],"standard_charges":[{"gross_charge":5.81,"discounted_cash":2.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9990-29","type":"NDC"}],"standard_charges":[{"gross_charge":5.68,"discounted_cash":2.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"00093-9020-19","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"00093-9020-65","type":"NDC"}],"standard_charges":[{"gross_charge":5.94,"discounted_cash":2.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) 10 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) IV SOLP BOLUS","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00121-1276-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00121-1276-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00527-1311-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % TOP CREA","drug_information":{"unit":"28","type":"GR"},"code_information":[{"code":"00904-5354-31","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE IN NS IRRIGATION (COMPOUNDED)","drug_information":{"unit":"515","type":"ML"},"code_information":[{"code":"09999-9998-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.18,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 0.8 G ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"43598-0478-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 0.8 G ORAL PWPK","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"43598-0478-90","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-PRAMOXINE 3.5-10,000-10 MG-UNIT-MG/GRAM TOP CREA","drug_information":{"unit":"28","type":"GR"},"code_information":[{"code":"46122-0244-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIMOZIDE 2 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0348-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VILAZODONE 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62332-0232-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.09,"discounted_cash":3.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EFAVIRENZ-EMTRICITABIN-TENOFOV 600-200-300 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65862-0497-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.15,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORICONAZOLE 200 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68462-0573-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 6 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"09999-9999-26","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 6 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"09999-9999-26","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 6 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"09999-9999-27","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN 6 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"09999-9999-27","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"00338-1055-48","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"00409-0152-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE IN NACL (ISO-OS) 500 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"00409-0152-24","type":"NDC"}],"standard_charges":[{"gross_charge":6.0,"discounted_cash":3.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"73293-0001-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"55150-0207-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.02,"discounted_cash":3.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE  100 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"00641-6175-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE  100 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"00641-6175-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  2.25 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"55150-0119-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.13,"discounted_cash":3.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG/ML INJ SOLN - FOR IM USE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2550","type":"HCPCS"},{"code":"00641-0928-21","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG/ML INJ SOLN - FOR IM USE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2550","type":"HCPCS"},{"code":"00641-0928-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.16,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 2 GRAM/50 ML NS IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"00000-0115-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 50 MG/ML EYE DROPS (COMPOUNDED)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"00000-0000-28","type":"NDC"}],"standard_charges":[{"gross_charge":6.04,"discounted_cash":3.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 2.4 G ORAL PWPK","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"00115-1366-29","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVELAMER CARBONATE 2.4 G ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00115-1366-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00143-9888-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE  4.6 MG/24 HOUR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9070-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVASTIGMINE  4.6 MG/24 HOUR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00378-9070-93","type":"NDC"}],"standard_charges":[{"gross_charge":6.22,"discounted_cash":3.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN 100 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9997-16","type":"NDC"}],"standard_charges":[{"gross_charge":6.4,"discounted_cash":3.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 283 MG/5 ML RECT ENEM","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"17433-9876-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM 283 MG/5 ML RECT ENEM","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"17433-9876-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN (ADULT) RECT SUPP - BULK","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"46122-0221-63","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN (CHILD) RECT SUPP - BULK","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"46122-0222-63","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 300 MG ORAL CM12","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50268-0172-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 300 MG ORAL CM12","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"50268-0172-13","type":"NDC"}],"standard_charges":[{"gross_charge":6.53,"discounted_cash":3.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 650 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62559-0265-30","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE 10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0017-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.44,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIMETHOPRIM 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0541-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE HCL  2 MG SL SUBL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0571","type":"HCPCS"},{"code":"60687-0481-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE HCL  2 MG SL SUBL","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J0571","type":"HCPCS"},{"code":"60687-0481-21","type":"NDC"}],"standard_charges":[{"gross_charge":6.28,"discounted_cash":3.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0780","type":"HCPCS"},{"code":"25021-0790-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.2,"discounted_cash":3.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE)  1000 UNITS/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"71288-0402-11","type":"NDC"}],"standard_charges":[{"gross_charge":6.56,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1939","type":"HCPCS"},{"code":"70860-0405-04","type":"NDC"}],"standard_charges":[{"gross_charge":6.55,"discounted_cash":3.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"63323-0452-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"63323-0452-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":3.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"00000-0075-96","type":"NDC"}],"standard_charges":[{"gross_charge":6.24,"discounted_cash":3.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE-GLYCERIN-WATER (123) ENEMA","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0043-57","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML ORAL SU12","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0097-72","type":"NDC"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE 20 MG TABLET #15 ED PACK","drug_information":{"unit":"15","type":"UN"},"code_information":[{"code":"00000-0102-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":3.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASAGILINE 0.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00093-3060-56","type":"NDC"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":3.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECT, BACTERIOSTAT INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00409-3977-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECT, BACTERIOSTAT INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00409-3977-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.6,"discounted_cash":3.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RACEPINEPHRINE 2.25 % INHL NEBU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00487-5901-99","type":"NDC"}],"standard_charges":[{"gross_charge":6.87,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SALICYLIC ACID-SULFUR 2-2 % TOP SHAM","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00536-1962-97","type":"NDC"}],"standard_charges":[{"gross_charge":6.61,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-27","type":"NDC"}],"standard_charges":[{"gross_charge":6.82,"discounted_cash":3.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTHIXENE  2 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"51079-0587-20","type":"NDC"}],"standard_charges":[{"gross_charge":6.61,"discounted_cash":3.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0496-97","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % TOP CREA","drug_information":{"unit":"28.4","type":"GR"},"code_information":[{"code":"68001-0481-45","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 0.3 MG/ML IV DILUTION KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"09999-9997-49","type":"NDC"}],"standard_charges":[{"gross_charge":7.01,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 3 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"67457-0855-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 3 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"67457-0855-02","type":"NDC"}],"standard_charges":[{"gross_charge":6.99,"discounted_cash":3.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 0.5 MG/ML IV SYRINGE FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-10","type":"NDC"}],"standard_charges":[{"gross_charge":6.8,"discounted_cash":3.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  1 MG/ML INJ RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  1 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-03","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  1 MG/ML INJ RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  1 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-31","type":"NDC"}],"standard_charges":[{"gross_charge":6.93,"discounted_cash":3.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 10 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"09999-9999-50","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 25 % 25 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"00409-4031-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 25 % 25 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2150","type":"HCPCS"},{"code":"00409-4031-16","type":"NDC"}],"standard_charges":[{"gross_charge":7.0,"discounted_cash":3.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"63323-0454-00","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"63323-0454-01","type":"NDC"}],"standard_charges":[{"gross_charge":6.64,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 10 MG/ML IV EMUL","drug_information":{"unit":"200","type":"ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"00409-6010-25","type":"NDC"}],"standard_charges":[{"gross_charge":6.72,"discounted_cash":3.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-7299-73","type":"NDC"}],"standard_charges":[{"gross_charge":6.88,"discounted_cash":3.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0061-17","type":"NDC"}],"standard_charges":[{"gross_charge":7.32,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 5-325 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0087-60","type":"NDC"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLR (UNIT DOSE)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0100-72","type":"NDC"}],"standard_charges":[{"gross_charge":7.4,"discounted_cash":3.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2.1 % (W/V) ORAL SUSP  450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0723-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPH-MIN OIL-PETROLATUM 0.25-14-74.9 % RECT OINT","drug_information":{"unit":"57","type":"GR"},"code_information":[{"code":"46122-0677-46","type":"NDC"}],"standard_charges":[{"gross_charge":7.3,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID  500 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"70377-0102-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"72485-0422-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"72485-0422-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  1.5 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"72485-0416-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  1.5 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"72485-0416-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.27,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE-NALOXONE 8-2 MG SL SUBL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0574","type":"HCPCS"},{"code":"60687-0637-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPRENORPHINE-NALOXONE 8-2 MG SL SUBL","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"J0574","type":"HCPCS"},{"code":"60687-0637-65","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1312-03","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SYRG RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1312-03","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1312-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE  2 MG/ML INJ SYRG RESPIRATORY","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1312-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 0.1 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"09999-9999-21","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 5 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"00000-0038-46","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 5 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1836","type":"HCPCS"},{"code":"00000-0038-46","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 5 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"00409-0125-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 5 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"00409-0125-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.36,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6001-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6001-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6001-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.03,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"00641-6001-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"09999-9999-97","type":"NDC"}],"standard_charges":[{"gross_charge":7.05,"discounted_cash":3.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  3.375 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"55150-0120-30","type":"NDC"}],"standard_charges":[{"gross_charge":7.43,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 5 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70860-0301-05","type":"NDC"}],"standard_charges":[{"gross_charge":7.1,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROCURONIUM 10 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"71839-0141-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROCURONIUM 10 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"71839-0141-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.42,"discounted_cash":3.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5% IN WATER (D5W) LINE CARE - 100 ML BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-38","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5% IN WATER (D5W) LINE CARE - 100 ML BAG","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00409-7923-37","type":"NDC"}],"standard_charges":[{"gross_charge":7.2,"discounted_cash":3.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"00143-9519-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.33,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN  50 ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-61","type":"NDC"}],"standard_charges":[{"gross_charge":7.35,"discounted_cash":3.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"35","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0350-35","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":3.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE BYPASS BUFFER","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00000-0037-26","type":"NDC"}],"standard_charges":[{"gross_charge":7.49,"discounted_cash":3.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"236","type":"ML"},"code_information":[{"code":"00000-0040-12","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DRPS (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0057-55","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN VK 500 MG TABLET #8 ED PACK","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"00000-0063-33","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIMANTADINE 100 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00115-1911-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.58,"discounted_cash":3.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL RECT ENEM","drug_information":{"unit":"133","type":"ML"},"code_information":[{"code":"00132-0301-40","type":"NDC"}],"standard_charges":[{"gross_charge":7.45,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BISMUTH SUBSALICYLATE 262 MG/15 ML ORAL SUSP","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"00536-1286-36","type":"NDC"}],"standard_charges":[{"gross_charge":7.59,"discounted_cash":3.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DRPS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00536-1303-75","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETIRIZINE  1 MG/ML ORAL SOLN","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00904-6765-20","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 600 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0309-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 600 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0309-21","type":"NDC"}],"standard_charges":[{"gross_charge":7.46,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 100 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0687-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"60687-0687-57","type":"NDC"}],"standard_charges":[{"gross_charge":7.51,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMETHICONE 40 MG/0.6 ML ORAL DRPS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"71399-0041-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":3.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 150 MG/100 ML OF D5W BOLUS KIT","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"00000-0048-42","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE  20 MG/ML S.O.","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71266-2001-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE  20 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71288-0719-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE  20 MG/ML S.O.","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71288-0719-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE  20 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71288-0719-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE  20 MG/ML S.O.","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71288-0719-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE 400 MG/5 ML (80 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00517-1905-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.5,"discounted_cash":3.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  25 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00641-6052-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  25 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00641-6052-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.53,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"00641-6149-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"00641-6149-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00641-6027-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00641-6027-25","type":"NDC"}],"standard_charges":[{"gross_charge":7.52,"discounted_cash":3.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"63323-0965-10","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":3.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 200 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0057-31","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TMP 800-160 MG #14 ED PACK","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"00000-0087-91","type":"NDC"}],"standard_charges":[{"gross_charge":7.62,"discounted_cash":3.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRIMAQUINE 26.3 MG (15 MG BASE) ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00024-1596-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.63,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIPASE-PROTEASE-AMYLASE 6,000-19,000 -30,000 UNIT ORAL CPDR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00032-1206-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":3.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 200 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00143-9886-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.65 % NASL DROP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00225-0382-80","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL  60 MG ORAL CP12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-6060-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.86,"discounted_cash":3.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"09999-9997-13","type":"NDC"}],"standard_charges":[{"gross_charge":7.9,"discounted_cash":3.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 125 MG/5 ML SUSP 150 ML ED PACK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"09999-9997-63","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLESTIPOL 5 G ORAL PACK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59762-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0406-40","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0406-77","type":"NDC"}],"standard_charges":[{"gross_charge":7.64,"discounted_cash":3.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISRADIPINE  2.5 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"64850-0910-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.88,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIPASE-PROTEASE-AMYLASE 5,000-17,000- 24,000 UNIT ORAL CPDR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"73562-0115-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":3.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN (KEFZOL) 2 G/50 ML NS IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00000-0048-37","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE IN D5W 200 MG/100 ML (2,000 MCG/ML) INFUSION - NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"09999-9991-42","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN *PF* SYRINGE NICU","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0173-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE (PED) (PF) 20 MG/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0173-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN *PF* SYRINGE NICU","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0173-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN SULFATE (PED) (PF) 20 MG/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0173-02","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":3.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9720-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9720-24","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9721-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00143-9721-24","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00409-4444-01","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150 ML IV PGBK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1956","type":"HCPCS"},{"code":"00409-4444-24","type":"NDC"}],"standard_charges":[{"gross_charge":7.8,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 100 MG/100 ML IN NS INFUSION - PRMC","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1134-99","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 100 MG/100 ML IN NS INFUSION - PVH","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9999-04","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 100 MG/100 ML SUBQ INFUSION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9999-04","type":"NDC"}],"standard_charges":[{"gross_charge":7.6,"discounted_cash":3.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN  50 ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-08","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN  50 ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-89","type":"NDC"}],"standard_charges":[{"gross_charge":7.95,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00338-0553-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL  90 MG ORAL CP12","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00378-6090-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.1,"discounted_cash":4.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  60 MG ORAL TBER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00406-8380-23","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  60 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-8380-62","type":"NDC"}],"standard_charges":[{"gross_charge":8.22,"discounted_cash":4.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-7101-66","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYL SALICYLATE-MENTHOL 15-10 % TOP CREA","drug_information":{"unit":"85","type":"GR"},"code_information":[{"code":"04116-7060-03","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARIFENACIN 15 MG ORAL TB24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"33342-0277-07","type":"NDC"}],"standard_charges":[{"gross_charge":8.08,"discounted_cash":4.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0698-11","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"60687-0698-57","type":"NDC"}],"standard_charges":[{"gross_charge":7.96,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 1000 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70710-1302-06","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 1000 MG RECT SUPP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"70710-1302-07","type":"NDC"}],"standard_charges":[{"gross_charge":7.98,"discounted_cash":3.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00409-3613-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-DEXTROSE-WATER(PF) 0.75 % (7.5 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00409-3613-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE HCL 0.25 % (2.5 MG/ML) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0249-50","type":"NDC"}],"standard_charges":[{"gross_charge":8.2,"discounted_cash":4.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 30 MG/0.3 ML SUBQ SYRG","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0109-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":4.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 2 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"00641-6079-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.16,"discounted_cash":4.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE-D5-0.9%NACL 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7107-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% KCL 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7115-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN 0.9%NACL 40 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7116-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE-D5-0.2%NACL 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7901-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORID-D5-0.45%NACL 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7902-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORID-D5-0.45%NACL 30 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7903-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORID-D5-0.45%NACL 40 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7904-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORID-D5-0.45%NACL 10 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7993-09","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP FLEX CONTAINER 1000 ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"09999-9999-89","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % *HYPERTONIC* CONTINUOUS INFUSION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3% BOLUS FROM BAG","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3% BOLUS MIXTURE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3% INFUSION - LOCKED DOSE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"63323-0530-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % *HYPERTONIC* CONTINUOUS INFUSION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"63323-0530-75","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE  20 MG ORAL CAP","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"J8700","type":"HCPCS"},{"code":"67877-0538-07","type":"NDC"}],"standard_charges":[{"gross_charge":7.97,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"NOHCPCS","type":"HCPCS"},{"code":"00338-0049-48","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"NOHCPCS","type":"HCPCS"},{"code":"00990-7984-37","type":"NDC"}],"standard_charges":[{"gross_charge":8.0,"discounted_cash":4.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPIUM TINCTURE 10 MG/ML ORAL TINC","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"00000-0037-40","type":"NDC"}],"standard_charges":[{"gross_charge":8.39,"discounted_cash":4.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML - CMP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9997-28","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 400 MCG/100 ML FOR ECMO - CMP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9997-28","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL PRN PACK FOR H@H","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"09999-9998-72","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"09999-9998-72","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOP CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"51672-1282-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.28,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML FOR NERVE BLOCK INFILTRATION","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66794-0230-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66794-0230-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML FOR NERVE BLOCK INFILTRATION","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66794-0230-42","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 100 MCG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66794-0230-42","type":"NDC"}],"standard_charges":[{"gross_charge":8.36,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM  7.5 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0549-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.42,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMAZEPAM  7.5 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68084-0549-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.42,"discounted_cash":4.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68084-0823-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.37,"discounted_cash":4.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"68462-0639-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.4 MG SL SUBL","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"68462-0639-45","type":"NDC"}],"standard_charges":[{"gross_charge":8.3,"discounted_cash":4.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"81284-0611-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GALLIUM CITRATE GA 67","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"A9556","type":"HCPCS"},{"code":"09999-9900-92","type":"NDC"}],"standard_charges":[{"gross_charge":8.29,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 200 MG/100 ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"25021-0192-82","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4278-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 5 MG/ML (0.5 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4278-16","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"76045-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  4 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2272","type":"HCPCS"},{"code":"76045-0005-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.43,"discounted_cash":4.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9506-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON HCL 1 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"51991-0735-20","type":"NDC"}],"standard_charges":[{"gross_charge":8.28,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON HCL 1 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q0166","type":"HCPCS"},{"code":"51991-0735-99","type":"NDC"}],"standard_charges":[{"gross_charge":8.28,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"00069-6001-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 100 MG PE/2 ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"00069-6001-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.4,"discounted_cash":4.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0051-94","type":"NDC"}],"standard_charges":[{"gross_charge":8.56,"discounted_cash":4.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 2 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9999-65","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRISEOFULVIN ULTRAMICROSIZE 125 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"23155-0863-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.66,"discounted_cash":4.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATAZANAVIR 200 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"42385-0921-60","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM TOP GEL","drug_information":{"unit":"368","type":"GR"},"code_information":[{"code":"46122-0714-27","type":"NDC"}],"standard_charges":[{"gross_charge":8.84,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN-WITCH HAZEL 12.5-50 % TOP PADM","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"50289-3250-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 150 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60687-0575-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 150 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"60687-0575-21","type":"NDC"}],"standard_charges":[{"gross_charge":8.81,"discounted_cash":4.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN NO ROUNDING","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"61990-0611-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN NO ROUNDING","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"61990-0611-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"81284-0611-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"81284-0611-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANEXAMIC ACID 1,000 MG/10 ML (100 MG/ML) NEBULIZATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"81284-0611-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.52,"discounted_cash":4.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 7 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"09999-9999-88","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 7 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"09999-9999-88","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00409-2585-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00409-2585-11","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1626","type":"HCPCS"},{"code":"00143-9744-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GRANISETRON HCL 1 MG/ML (1 ML) IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1626","type":"HCPCS"},{"code":"00143-9744-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.78,"discounted_cash":4.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) 5000 UNITS/ML NEB SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"00641-0400-12","type":"NDC"}],"standard_charges":[{"gross_charge":8.6,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) 5000 UNITS/ML NEB SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"00641-0400-37","type":"NDC"}],"standard_charges":[{"gross_charge":8.6,"discounted_cash":4.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00641-6054-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00641-6054-25","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":4.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE   50 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"00641-6174-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE ACETATE   50 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"00641-6174-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.58,"discounted_cash":4.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 4 GRAM/100 ML (4 %) IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0106-00","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 4 GRAM/100 ML (4 %) IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0106-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.8,"discounted_cash":4.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9785-01","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROATE SODIUM 500 MG/5 ML (100 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9785-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.76,"discounted_cash":4.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0040-74","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSP","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00000-0078-66","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN  100 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0094-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.12,"discounted_cash":4.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00143-9889-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":4.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SURGICAL LUBRICANT JELLY TOP GEL","drug_information":{"unit":"56.7","type":"GR"},"code_information":[{"code":"00281-0205-02","type":"NDC"}],"standard_charges":[{"gross_charge":8.85,"discounted_cash":4.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-1749-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-4887-50","type":"NDC"}],"standard_charges":[{"gross_charge":9.0,"discounted_cash":4.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 1.2 GRAM /3 ML (40 %) ORAL GLSL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"05475-8006-28","type":"NDC"}],"standard_charges":[{"gross_charge":9.22,"discounted_cash":4.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MONTELUKAST  4 MG ORAL GRPK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"27241-0015-31","type":"NDC"}],"standard_charges":[{"gross_charge":9.2,"discounted_cash":4.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAMPHOR-MENTHOL 0.5-0.5 % (SARNA) LOTION","drug_information":{"unit":"222","type":"ML"},"code_information":[{"code":"46122-0573-10","type":"NDC"}],"standard_charges":[{"gross_charge":8.88,"discounted_cash":4.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   1 MG ORAL TBDL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49884-0315-52","type":"NDC"}],"standard_charges":[{"gross_charge":8.93,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE   1 MG ORAL TBDL","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"49884-0315-91","type":"NDC"}],"standard_charges":[{"gross_charge":8.93,"discounted_cash":4.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 2.5 % TOP CREA","drug_information":{"unit":"28.35","type":"GR"},"code_information":[{"code":"51672-3003-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.19,"discounted_cash":4.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN 400 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"72205-0001-30","type":"NDC"}],"standard_charges":[{"gross_charge":8.86,"discounted_cash":4.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"60505-6146-00","type":"NDC"}],"standard_charges":[{"gross_charge":9.23,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"60505-6146-04","type":"NDC"}],"standard_charges":[{"gross_charge":9.23,"discounted_cash":4.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"44567-0245-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.32,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7335-03","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7335-13","type":"NDC"}],"standard_charges":[{"gross_charge":9.02,"discounted_cash":4.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1165","type":"HCPCS"},{"code":"00641-2555-45","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF)  1 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.17,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF)  1 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-11","type":"NDC"}],"standard_charges":[{"gross_charge":9.17,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"55150-0235-02","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM BROMIDE 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"55150-0235-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.14,"discounted_cash":4.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALGANCICLOVIR 450 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"31722-0832-60","type":"NDC"}],"standard_charges":[{"gross_charge":9.04,"discounted_cash":4.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML ORAL SOLUTION","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"00000-0035-85","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOPROPYL ALCOHOL 99 % MISC SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-0066-16","type":"NDC"}],"standard_charges":[{"gross_charge":9.46,"discounted_cash":4.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTIAN VIOLET 1 % TOP SOLN","drug_information":{"unit":"59","type":"ML"},"code_information":[{"code":"24385-0003-46","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE  60 % (W/V) ORAL SUSP 1900 ML BTL","drug_information":{"unit":"1900","type":"ML"},"code_information":[{"code":"32909-0186-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.5,"discounted_cash":4.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"63323-0187-30","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.25 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"64980-0513-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISATRACURIUM 2 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"71288-0712-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"63323-0325-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIKACIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"09999-9999-85","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN (KEFZOL) 3 G/100 ML NS IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00000-0048-40","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME 100 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"09999-9999-76","type":"NDC"}],"standard_charges":[{"gross_charge":9.56,"discounted_cash":4.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-04","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-04","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.48,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-1283-05","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-96","type":"NDC"}],"standard_charges":[{"gross_charge":9.7,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 0.5 MG/0.5 ML S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"76045-0009-96","type":"NDC"}],"standard_charges":[{"gross_charge":9.59,"discounted_cash":4.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE)  5000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"81952-0111-01","type":"NDC"}],"standard_charges":[{"gross_charge":9.69,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE)  5000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"81952-0111-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.69,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR 0.5 UNITS/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9999-52","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00143-9577-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.6,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE 25 MCG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J2354","type":"HCPCS"},{"code":"09999-9999-38","type":"NDC"}],"standard_charges":[{"gross_charge":9.4,"discounted_cash":4.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"70069-0063-25","type":"NDC"}],"standard_charges":[{"gross_charge":9.44,"discounted_cash":4.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-28","type":"NDC"}],"standard_charges":[{"gross_charge":9.68,"discounted_cash":4.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 12.5 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0536-06","type":"NDC"}],"standard_charges":[{"gross_charge":9.32,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 12.5 MG RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0536-12","type":"NDC"}],"standard_charges":[{"gross_charge":9.32,"discounted_cash":4.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3)  400 UNITS ORAL DROP (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0089-49","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE  400 MG ORAL CDTI","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"00093-5907-86","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROQUINE PHOSPHATE 250 MG ORAL TAB","drug_information":{"unit":"50","type":"UN"},"code_information":[{"code":"00115-2790-06","type":"NDC"}],"standard_charges":[{"gross_charge":10.16,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE-ALOE VERA NASL GEL","drug_information":{"unit":"14.1","type":"GR"},"code_information":[{"code":"00225-0525-47","type":"NDC"}],"standard_charges":[{"gross_charge":9.76,"discounted_cash":4.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-1746-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.04,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUM-MAG HYDROXIDE-SIMETH 200-200-20 MG/5 ML ORAL SUSP","drug_information":{"unit":"355","type":"ML"},"code_information":[{"code":"00536-1293-83","type":"NDC"}],"standard_charges":[{"gross_charge":9.94,"discounted_cash":4.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 5 G TD GLPK","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"00591-3217-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":5.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPERAMIDE 1 MG/7.5 ML ORAL LIQD","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00904-6836-20","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHOLECALCIFEROL (VITAMIN D3)  400 UNITS ORAL DROP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"07139-9740-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP FLEX CONTAINER 100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9999-08","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEMECLOCYCLINE 150 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"42806-0143-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.05,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 490-640 MG/5 ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"46287-0014-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":5.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"63323-0626-55","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"63323-0626-55","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7333-04","type":"NDC"}],"standard_charges":[{"gross_charge":10.01,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7333-11","type":"NDC"}],"standard_charges":[{"gross_charge":10.01,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME 50 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"09999-9999-69","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 40 MG/0.4 ML SUBQ SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0110-10","type":"NDC"}],"standard_charges":[{"gross_charge":9.99,"discounted_cash":5.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM NICU STOCK SOLUTION","drug_information":{"unit":"22.5","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9999-32","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM PEDS STOCK SOLUTION","drug_information":{"unit":"22.5","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9999-32","type":"NDC"}],"standard_charges":[{"gross_charge":10.17,"discounted_cash":5.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP - PEDIATRIC","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% (IN ML/KG)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP - FOR ARTERIAL LINE / DILUTION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE  25 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J7515","type":"HCPCS"},{"code":"60505-0133-00","type":"NDC"}],"standard_charges":[{"gross_charge":10.05,"discounted_cash":5.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5%-0.2 % SOD CHLORIDE IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7924-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) IV SOLP (WEIGHT BASED)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASTOR OIL 100 % ORAL OIL (ANY SIZE)","drug_information":{"unit":"177","type":"ML"},"code_information":[{"code":"00000-0071-96","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00121-1576-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 5 G TD GLPK","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"00591-3217-26","type":"NDC"}],"standard_charges":[{"gross_charge":10.18,"discounted_cash":5.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE-COD LIVER OIL 40 % TOP PSTE","drug_information":{"unit":"57","type":"GR"},"code_information":[{"code":"07430-0000-70","type":"NDC"}],"standard_charges":[{"gross_charge":10.49,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL 2.5 MG PACK FOR H@H","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"09999-9998-73","type":"NDC"}],"standard_charges":[{"gross_charge":10.56,"discounted_cash":5.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE CENTRAL 0.12 MMOL/ML - FROM NICU STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9999-22","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CASTOR OIL 100 % ORAL OIL","drug_information":{"unit":"177","type":"ML"},"code_information":[{"code":"24385-0515-30","type":"NDC"}],"standard_charges":[{"gross_charge":10.62,"discounted_cash":5.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2 % (W/V) ORAL SUSP (BANANA) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0742-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN ZINC-POLYMYXIN B 500-10,000 UNIT/GRAM TOP OINT","drug_information":{"unit":"14.2","type":"GR"},"code_information":[{"code":"58980-0012-05","type":"NDC"}],"standard_charges":[{"gross_charge":10.51,"discounted_cash":5.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 20 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"00641-6231-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 20 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"00641-6231-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.25 % (2.5 MG/ML) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00143-9333-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.32,"discounted_cash":5.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN 100 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"09999-9999-77","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 400 MG/200 ML IVPB","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J0744","type":"HCPCS"},{"code":"25021-0114-87","type":"NDC"}],"standard_charges":[{"gross_charge":10.4,"discounted_cash":5.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00143-9252-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE 200 MG/5 ML (40 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00143-9252-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":5.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"70700-0167-22","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":5.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"70700-0167-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":5.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 0.4 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2060","type":"HCPCS"},{"code":"09999-9999-48","type":"NDC"}],"standard_charges":[{"gross_charge":10.72,"discounted_cash":5.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 10 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"09999-9999-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.44,"discounted_cash":5.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"67457-0621-02","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML INJ SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"67457-0621-99","type":"NDC"}],"standard_charges":[{"gross_charge":10.25,"discounted_cash":5.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"65145-0129-01","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":5.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIAMINE HCL (VITAMIN B1) 100 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3411","type":"HCPCS"},{"code":"65145-0129-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.6,"discounted_cash":5.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"09999-9999-61","type":"NDC"}],"standard_charges":[{"gross_charge":10.48,"discounted_cash":5.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0350-50","type":"NDC"}],"standard_charges":[{"gross_charge":10.3,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISDEXAMFETAMINE 50 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-5115-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD BORATE-BORIC AC-NACL-WATER OPHT IRSL","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00536-1224-97","type":"NDC"}],"standard_charges":[{"gross_charge":10.86,"discounted_cash":5.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBETASOL 0.05 % TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00713-0656-15","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANOLIN ALCOHOL-MO-W.PET-CERES TOP CREA","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"00904-7751-27","type":"NDC"}],"standard_charges":[{"gross_charge":10.9,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMEPRAZOLE 2 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"09999-9997-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2.1 % (W/V) ORAL SUSP (BERRY) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0715-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2 % (W/V) ORAL SUSP (BERRY) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0741-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2 % (W/V) ORAL SUSP (VANILLA) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0746-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2.1 % (W/V) ORAL SUSP (VANILLA) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0755-03","type":"NDC"}],"standard_charges":[{"gross_charge":10.8,"discounted_cash":5.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASENAPINE MALEATE  5 MG SL SUBL","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"42794-0016-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE 1 % OPHT DROP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"61314-0396-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN 2 % TOP OINT","drug_information":{"unit":"22","type":"GR"},"code_information":[{"code":"68462-0180-22","type":"NDC"}],"standard_charges":[{"gross_charge":11.09,"discounted_cash":5.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  1.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"00409-2689-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  1.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"00409-2689-21","type":"NDC"}],"standard_charges":[{"gross_charge":11.11,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"70860-0100-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"70860-0100-41","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"44567-0235-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.89,"discounted_cash":5.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"63323-0851-10","type":"NDC"}],"standard_charges":[{"gross_charge":10.96,"discounted_cash":5.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"00409-1207-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"00409-1207-13","type":"NDC"}],"standard_charges":[{"gross_charge":11.04,"discounted_cash":5.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"63323-0486-57","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  50 MG/ML INJ SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00000-0159-54","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN   1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"44567-0221-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.19,"discounted_cash":5.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  50 MG/ML INJ SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"63037-0137-25","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":5.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM  2.5 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"J8610","type":"HCPCS"},{"code":"00904-7141-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.12,"discounted_cash":5.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLEXIBLE COLLODION (BULK) MISC LIQD","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0039-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.64,"discounted_cash":5.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 75 MG/ML ORAL DROP (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0096-00","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISDEXAMFETAMINE 20 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-5112-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISDEXAMFETAMINE 30 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00406-5113-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.35,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-4283-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-4283-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 40 MG/ML (4 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-4283-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARENTERAL AMINO ACID 15% NO.2 15 % IV SOLP","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"00409-7122-07","type":"NDC"}],"standard_charges":[{"gross_charge":11.2,"discounted_cash":5.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIBUCAINE 1 % TOP OINT","drug_information":{"unit":"28","type":"GR"},"code_information":[{"code":"00536-1211-95","type":"NDC"}],"standard_charges":[{"gross_charge":11.54,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MINERAL OIL ORAL OIL","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00869-4206-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 75 MG/ML (15 MG IRON/ML) ORAL DROP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"07139-9748-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 333 MG ORAL TBEC","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"52536-0183-03","type":"NDC"}],"standard_charges":[{"gross_charge":11.25,"discounted_cash":5.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 2.5 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"70710-1643-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":5.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 2.5 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"70710-1643-07","type":"NDC"}],"standard_charges":[{"gross_charge":11.41,"discounted_cash":5.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.5 % (5 MG/ML) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0170-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"00641-1410-31","type":"NDC"}],"standard_charges":[{"gross_charge":11.44,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 250 MCG/ML (0.25 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"00641-1410-35","type":"NDC"}],"standard_charges":[{"gross_charge":11.44,"discounted_cash":5.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 3000 MCG/30 ML (100 MCG/ML) SYRINGE","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"00000-0116-15","type":"NDC"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":5.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 1.5 MCG/ML - BUPIVACAINE 0.125% EPIDURAL","drug_information":{"unit":"132","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-0099-73","type":"NDC"}],"standard_charges":[{"gross_charge":11.62,"discounted_cash":5.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 500 MG INJ **TOPICAL** USE","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-4332-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 500 MG INJ **TOPICAL** USE","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-4332-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 500 MG INJ **TOPICAL** USE","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-6534-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 500 MG INJ **TOPICAL** USE","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-6534-11","type":"NDC"}],"standard_charges":[{"gross_charge":11.58,"discounted_cash":5.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML INTRA-CATHETER INSTILLATION - NICU/PEDS","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9999-28","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":5.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9999-28","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":5.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9999-28","type":"NDC"}],"standard_charges":[{"gross_charge":11.6,"discounted_cash":5.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.1 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9784-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.1 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9784-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.26,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9990-30","type":"NDC"}],"standard_charges":[{"gross_charge":11.36,"discounted_cash":5.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSR 100 ML ED PACK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0000-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE 30 MG TABLET #3 ED PACK","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"00000-0063-29","type":"NDC"}],"standard_charges":[{"gross_charge":11.97,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETHANECHOL 1 MG/ML SOLUTION","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"00000-0070-81","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0081-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL (BULK)  89 % MISC LIQD","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0108-82","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.1 MG/ML SUSPENSION","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0194-37","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 400 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00143-9887-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPSAICIN 0.025 % TOP CREA","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"00536-2525-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.76,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DABIGATRAN ETEXILATE 150 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00597-0360-82","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  0.125 % NASL DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"05618-4121-05","type":"NDC"}],"standard_charges":[{"gross_charge":11.94,"discounted_cash":5.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASENAPINE MALEATE 10 MG SL SUBL","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"42794-0017-10","type":"NDC"}],"standard_charges":[{"gross_charge":11.78,"discounted_cash":5.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 0.5 % TOP CREA","drug_information":{"unit":"28.4","type":"GR"},"code_information":[{"code":"51672-2010-02","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 20 MG ORAL CAP","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68462-0120-90","type":"NDC"}],"standard_charges":[{"gross_charge":11.87,"discounted_cash":5.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPHENIDATE HCL  10 MG ORAL MP50","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70010-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.71,"discounted_cash":5.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"71839-0143-01","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE BITARTRATE 1 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"71839-0143-25","type":"NDC"}],"standard_charges":[{"gross_charge":11.75,"discounted_cash":5.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 450 MG/250 ML (1.8 MG/ML) IN D5W INFUSION KIT","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"00000-0103-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE 450 MG/250 ML (1.8 MG/ML) IN D5W INFUSION KIT (FIRST DOSE)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0282","type":"HCPCS"},{"code":"00000-0103-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00009-0775-26","type":"NDC"}],"standard_charges":[{"gross_charge":11.81,"discounted_cash":5.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7042","type":"HCPCS"},{"code":"00990-7941-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 %-0.45 % SODIUM CHLORIDE IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7926-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) 10 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) IV SOLP BOLUS","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMPTY BRAUN CONTAINER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-2101-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYSIOLOGICAL IRRIG SOLN NO.1 140-5-3-98 MEQ/L IR SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00264-2205-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELECTROLYTE-S IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00264-7703-00","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS FOR IRRIGATION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LISINOPRIL 1 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9901-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.4,"discounted_cash":6.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE IN NS IRRIGATION (COMPOUNDED)","drug_information":{"unit":"1030","type":"ML"},"code_information":[{"code":"09999-9997-43","type":"NDC"}],"standard_charges":[{"gross_charge":12.36,"discounted_cash":6.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GRAM/DOSE ORAL POWD","drug_information":{"unit":"238","type":"GR"},"code_information":[{"code":"46122-0014-33","type":"NDC"}],"standard_charges":[{"gross_charge":12.38,"discounted_cash":6.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VERAPAMIL 100 MG ORAL CPCT","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"62175-0485-37","type":"NDC"}],"standard_charges":[{"gross_charge":12.05,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARUNAVIR 800 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"68180-0346-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 30 MG/ML IV SYRINGE - DOSES UNDER 500MG FROM STOCK SOLUTION","drug_information":{"unit":"67","type":"ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"06666-6666-67","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":6.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 30 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"67","type":"ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"06666-6666-67","type":"NDC"}],"standard_charges":[{"gross_charge":12.21,"discounted_cash":6.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE FOR DESENSITIZATION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.3,"discounted_cash":6.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 300 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9545-24","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 300 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9545-50","type":"NDC"}],"standard_charges":[{"gross_charge":12.2,"discounted_cash":6.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"63323-0492-97","type":"NDC"}],"standard_charges":[{"gross_charge":12.04,"discounted_cash":6.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 4 MG/ML IV SYRINGE - STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"09999-9999-35","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0361-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0361-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.18,"discounted_cash":6.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IRRIGATION BAGS FOR VERAFLOW MACHINES","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% FOR LINE CARE - 1000 ML BAG","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV FLEX CONTAINER 250 ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"09999-9999-06","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5% IN WATER (D5W) IV FLEX CONTAINER 1000 ML","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"09999-9999-90","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS FOR LINE CARE","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV (WEIGHT BASED)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"NOHCPCS","type":"HCPCS"},{"code":"00990-7983-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.0,"discounted_cash":6.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00000-0039-89","type":"NDC"}],"standard_charges":[{"gross_charge":12.75,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 50 MG/ML SUSPENSION 120 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0049-59","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 50 MG/ML SUSPENSION 120 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0057-60","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID-ASCORBATE CALC 500 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0090-20","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00517-7604-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.63,"discounted_cash":6.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00713-0678-15","type":"NDC"}],"standard_charges":[{"gross_charge":12.66,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM HYDROX-MAGNESIUM CARB 95-358 MG/15 ML ORAL SUSP","drug_information":{"unit":"355","type":"ML"},"code_information":[{"code":"00904-7727-14","type":"NDC"}],"standard_charges":[{"gross_charge":12.78,"discounted_cash":6.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAMPHOR-EUCALYPTUS OIL-MENTHOL 4.8-1.2-2.6 % TOP OINT","drug_information":{"unit":"50","type":"GR"},"code_information":[{"code":"02390-0003-61","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE PERIPHERAL 0.05 MMOL/ML - FROM NICU STOCK SOLUTION","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9999-23","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-TRANSPARENT DRESSING 4 % TOP KIT","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"24357-0701-07","type":"NDC"}],"standard_charges":[{"gross_charge":12.48,"discounted_cash":6.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 2.1 % (W/V) ORAL SUSP (MOCHA) 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0775-03","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 0.3 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0633-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"61314-0656-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.66,"discounted_cash":6.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM-MINERAL OIL CREAM","drug_information":{"unit":"107","type":"GR"},"code_information":[{"code":"61924-0174-04","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM 125 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3400-95","type":"NDC"}],"standard_charges":[{"gross_charge":12.46,"discounted_cash":6.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 1 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0360","type":"HCPCS"},{"code":"09999-9999-56","type":"NDC"}],"standard_charges":[{"gross_charge":12.72,"discounted_cash":6.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"71288-0200-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"71288-0200-11","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00641-6132-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00641-6132-25","type":"NDC"}],"standard_charges":[{"gross_charge":12.42,"discounted_cash":6.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 2 GRAM/50 ML (4 %) IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0106-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 2 GRAM/50 ML (4 %) IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0106-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.8,"discounted_cash":6.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYMYXIN B SULFATE 500000 UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"55150-0234-10","type":"NDC"}],"standard_charges":[{"gross_charge":12.68,"discounted_cash":6.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODIXANOL 320 MG IODINE/ML IV SOLN  50 ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"65219-0383-02","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODIXANOL 320 MG IODINE/ML IV SOLN  50 ML BTL","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"65219-0383-05","type":"NDC"}],"standard_charges":[{"gross_charge":12.6,"discounted_cash":6.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 1 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0066-38","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 490-640 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0094-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.44,"discounted_cash":6.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORHEXIDINE GLUCONATE 0.12 % MM MWSH","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00116-2001-16","type":"NDC"}],"standard_charges":[{"gross_charge":13.25,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  0.5 % NASL SPRY","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00225-0805-47","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":6.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM ACETATE 2 MEQ/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00409-8183-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.25 MG/2 ML INHL NBSP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00487-9601-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.88,"discounted_cash":6.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 100 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00904-6560-61","type":"NDC"}],"standard_charges":[{"gross_charge":13.06,"discounted_cash":6.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 100 MG/4 ML ORAL SUSP","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"17856-4070-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.93,"discounted_cash":6.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 100 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"52244-0100-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":6.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"68094-0750-59","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML, 5 ML) ORAL SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"68094-0750-62","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP OINT","drug_information":{"unit":"28.3","type":"GR"},"code_information":[{"code":"69396-0112-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":6.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"72578-0089-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"71288-0032-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"71288-0032-21","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"72485-0417-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"72485-0417-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.35,"discounted_cash":6.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"00641-6267-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CITRATE 60 MG/3 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"00641-6267-10","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALBUPHINE 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2300","type":"HCPCS"},{"code":"00409-1463-01","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":6.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALBUPHINE 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2300","type":"HCPCS"},{"code":"00409-1463-71","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":6.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 50 MCG/ML CONCENTRATED NICU INFUSION - ONE LINE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-31","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 50 MCG/ML OPIOID TOLERANT INGREDIENT","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-31","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 50 MCG/ML SUPPORTIVE CARE INGREDIENT NO HARD STOP","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-31","type":"NDC"}],"standard_charges":[{"gross_charge":13.28,"discounted_cash":6.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1000 MG INJ **TOPICAL** USE","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"67457-0340-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.42,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1000 MG INJ **TOPICAL** USE","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"67457-0340-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.42,"discounted_cash":6.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN 10 MG/ML IV SYRINGE - FROM STOCK SOLUTION -  CONTINUOUS INFUSION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9999-92","type":"NDC"}],"standard_charges":[{"gross_charge":13.2,"discounted_cash":6.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 10 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0457-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.04,"discounted_cash":6.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 10 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0457-20","type":"NDC"}],"standard_charges":[{"gross_charge":13.04,"discounted_cash":6.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL ELIX","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"00121-0489-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5 ML ORAL ELIX","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"00121-0489-05","type":"NDC"}],"standard_charges":[{"gross_charge":13.24,"discounted_cash":6.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE 6 MG/ML SUSPENSION 100 ML (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0002-72","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0040-77","type":"NDC"}],"standard_charges":[{"gross_charge":13.92,"discounted_cash":6.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0041-08","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 1 MG/ML SOLUTION 20 ML (ANY SIZE)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00000-0049-64","type":"NDC"}],"standard_charges":[{"gross_charge":13.52,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 200-28.5 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"00000-0077-00","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"00143-9889-15","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMMONIUM LACTATE 12 % TOP CREA","drug_information":{"unit":"140","type":"GR"},"code_information":[{"code":"00904-5983-48","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDRALAZINE 1 MG/ML SOLUTION 20 ML","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"09999-9900-88","type":"NDC"}],"standard_charges":[{"gross_charge":13.52,"discounted_cash":6.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPIRAMATE 6 MG/ML SUSPENSION 100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9991-72","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 2.5-108 MG/5 ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"09999-9997-08","type":"NDC"}],"standard_charges":[{"gross_charge":14.12,"discounted_cash":7.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML 50 ML ED PACK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9997-65","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 200-28.5 MG/5 ML ORAL SUSR","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"65862-0533-75","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":6.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5 ML ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"65862-0534-50","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":6.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIUM IN-111 OXYQUINOLINE 1 MCI/ML (37 MBQ/ML)(1 ML) IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"A9547","type":"HCPCS"},{"code":"17156-0021-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":7.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"00009-3073-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"70069-0062-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"70069-0062-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"70069-0064-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.16,"discounted_cash":7.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 4 GRAM/100 ML NS IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"00000-0115-04","type":"NDC"}],"standard_charges":[{"gross_charge":13.6,"discounted_cash":6.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00990-7922-02","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"63323-0624-74","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 %-LACTATED RINGERS IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7121","type":"HCPCS"},{"code":"00990-7929-03","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIROLIMUS 0.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7520","type":"HCPCS"},{"code":"68462-0682-01","type":"NDC"}],"standard_charges":[{"gross_charge":13.77,"discounted_cash":6.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN 100 ML BTL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-63","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":7.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL 1 MG/ML SOLUTION 200 ML","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"00000-0035-95","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 5 MG/ML SUSPENSION 60 ML","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0050-18","type":"NDC"}],"standard_charges":[{"gross_charge":14.64,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 10 GRAM/15 ML RETENTION ENEMA","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"00000-0053-83","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 5 MG/ML SUSPENSION 60 ML (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0062-78","type":"NDC"}],"standard_charges":[{"gross_charge":14.64,"discounted_cash":7.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMMONIUM LACTATE 12 % TOP LOTN","drug_information":{"unit":"226","type":"GR"},"code_information":[{"code":"00904-5984-26","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":7.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOCAINE 20 % TOP OINT","drug_information":{"unit":"28","type":"GR"},"code_information":[{"code":"06373-6037-51","type":"NDC"}],"standard_charges":[{"gross_charge":14.56,"discounted_cash":7.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 2 MG/ML SUSPENSION","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"09999-9900-87","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN 250 MG/5 ML SUSP 150 ML ED PACK","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"09999-9997-64","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % VAGL CREA","drug_information":{"unit":"45","type":"GR"},"code_information":[{"code":"24385-0590-29","type":"NDC"}],"standard_charges":[{"gross_charge":14.76,"discounted_cash":7.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRAZINAMIDE 500 MG ORAL TAB","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"70954-0484-20","type":"NDC"}],"standard_charges":[{"gross_charge":14.38,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN IN NACL (ISO-OSM)  80 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"00338-0503-48","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 5 MG/ML IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"72266-0103-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INJECTION","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"00143-9673-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 500 MG/5 ML INJECTION","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1953","type":"HCPCS"},{"code":"00143-9673-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0483-27","type":"NDC"}],"standard_charges":[{"gross_charge":14.24,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1253-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1253-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":7.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00641-6132-25","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJECTION S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"67457-0292-02","type":"NDC"}],"standard_charges":[{"gross_charge":14.71,"discounted_cash":7.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  0.1 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2372","type":"HCPCS"},{"code":"43598-0172-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  0.1 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2372","type":"HCPCS"},{"code":"43598-0172-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.46,"discounted_cash":7.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5 ML SUBQ SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J3030","type":"HCPCS"},{"code":"55150-0173-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.29,"discounted_cash":7.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN  500 MG IV SOLR","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-6534-01","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN  500 MG IV SOLR","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00409-6534-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN  500 MG IV SOLR","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"25021-0150-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":7.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN WATER  10 MEQ/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00338-0705-41","type":"NDC"}],"standard_charges":[{"gross_charge":14.4,"discounted_cash":7.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 5 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00641-6014-10","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":7.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCHLOROTHIAZIDE 5 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0002-68","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM  50 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-42","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 500 MG CAPSULE #40 ED PACK","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"00000-0087-88","type":"NDC"}],"standard_charges":[{"gross_charge":15.04,"discounted_cash":7.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00121-0595-00","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5 ML ORAL SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00121-0595-15","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4 % IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-6609-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 2.5 G TD GLPK","drug_information":{"unit":"2.5","type":"GR"},"code_information":[{"code":"00591-3216-17","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":7.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE 2.5 G TD GLPK","drug_information":{"unit":"2.5","type":"GR"},"code_information":[{"code":"00591-3216-30","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":7.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % TOP POWD","drug_information":{"unit":"85","type":"GR"},"code_information":[{"code":"08019-6528-56","type":"NDC"}],"standard_charges":[{"gross_charge":14.96,"discounted_cash":7.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NITRATE 2 % TOP OINT","drug_information":{"unit":"71","type":"GR"},"code_information":[{"code":"08438-9135-51","type":"NDC"}],"standard_charges":[{"gross_charge":15.06,"discounted_cash":7.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE CENTRAL 0.12 MMOL/ML - FROM NICU STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9999-18","type":"NDC"}],"standard_charges":[{"gross_charge":14.8,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"50268-0745-11","type":"NDC"}],"standard_charges":[{"gross_charge":14.92,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"50268-0745-14","type":"NDC"}],"standard_charges":[{"gross_charge":14.92,"discounted_cash":7.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE 1 % VAGL CREA","drug_information":{"unit":"45","type":"GR"},"code_information":[{"code":"51672-2003-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NELFINAVIR 250 MG ORAL TAB","drug_information":{"unit":"300","type":"UN"},"code_information":[{"code":"63010-0010-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"63323-0093-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.12,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME SODIUM   1.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"00143-9977-22","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFUROXIME SODIUM   1.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0697","type":"HCPCS"},{"code":"00143-9977-90","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE IN NACL (ISO-OSM) 200 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"25021-0184-82","type":"NDC"}],"standard_charges":[{"gross_charge":14.8,"discounted_cash":7.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"00409-9157-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.1,"discounted_cash":7.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00409-6653-05","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROCURONIUM 10 MG/ML IV SOLN - 10 ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"71839-0142-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROCURONIUM 10 MG/ML IV SOLN - 10 ML","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"71839-0142-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.08,"discounted_cash":7.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SHORT CHAIN FATTY ACID RECTAL ENEMA IN PURIFIED WATER","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0049-53","type":"NDC"}],"standard_charges":[{"gross_charge":15.36,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID (BULK)   5 % MISC LIQD","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0113-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00168-0002-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.54,"discounted_cash":7.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL","drug_information":{"unit":"31","type":"GR"},"code_information":[{"code":"02420-8024-01","type":"NDC"}],"standard_charges":[{"gross_charge":15.26,"discounted_cash":7.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL S.O.","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"05789-6709-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"05789-6709-16","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL 20 MG/ML SUSPENSION 100 ML (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9997-62","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"09999-9999-39","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-DEXTRIN-MALTOSE 24 GRAM/31 GRAM ORAL GEL FOR GLUCOMMANDER","drug_information":{"unit":"31","type":"GR"},"code_information":[{"code":"32420-8024-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (BULK) 100 % MISC POWD","drug_information":{"unit":"4","type":"GR"},"code_information":[{"code":"51552-0106-09","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":7.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 250 MG ORAL TBEC","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"52536-0180-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCUSATE SODIUM  50 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"71399-0039-06","type":"NDC"}],"standard_charges":[{"gross_charge":15.14,"discounted_cash":7.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-00","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 2 MMOL/2 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.21,"discounted_cash":7.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5084-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.62,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5084-13","type":"NDC"}],"standard_charges":[{"gross_charge":15.62,"discounted_cash":7.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"09999-9999-72","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00338-3612-24","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00338-3612-50","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0482-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0482-27","type":"NDC"}],"standard_charges":[{"gross_charge":15.44,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXACILLIN  1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"55150-0127-15","type":"NDC"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":7.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM 0.2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9999-29","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) IV SOLP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00409-6648-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.4,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 25 MG/ML EYE DROPS (COMPOUNDED)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"00000-0000-29","type":"NDC"}],"standard_charges":[{"gross_charge":15.2,"discounted_cash":7.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN 100 ML BTL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-91","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":7.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRIL 1 MG/ML SUSPENSION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0066-37","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR IRRIGATION, STERILE IR SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00264-2101-00","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-5555-02","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00409-5555-12","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00781-3269-71","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPHEDRINE SULFATE 50 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00781-3269-95","type":"NDC"}],"standard_charges":[{"gross_charge":16.11,"discounted_cash":8.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7990-09","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UREA 15 G ORAL PWPK","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"06253-0000-11","type":"NDC"}],"standard_charges":[{"gross_charge":15.96,"discounted_cash":7.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATAZANAVIR 300 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"42385-0922-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXANDROLONE  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"49884-0301-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE  7.5 % TOP SOLN","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"67618-0151-04","type":"NDC"}],"standard_charges":[{"gross_charge":16.05,"discounted_cash":8.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN  10 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9983-03","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN  10 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0690","type":"HCPCS"},{"code":"00143-9983-91","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":7.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"63323-0852-03","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"63323-0852-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":8.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN 5000 UNITS/1000 ML BAG FOR IR","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"09999-9998-60","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 60 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0111-10","type":"NDC"}],"standard_charges":[{"gross_charge":15.66,"discounted_cash":7.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"00409-1391-21","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"00409-1391-22","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"55150-0208-30","type":"NDC"}],"standard_charges":[{"gross_charge":15.71,"discounted_cash":7.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON 16 MG/50 ML IN NS IVPB","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2405","type":"HCPCS"},{"code":"00000-0054-29","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":8.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  50 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"65219-0188-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.16,"discounted_cash":8.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP FLEX CONTAINER 500 ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"09999-9999-09","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP FLEX CONTAINER 250 ML","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"09999-9999-57","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 240 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"99999-0240-50","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":8.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 23.4% *HYPERTONIC* SYRINGE","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0000-08","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML SOLUTION 30 ML (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0059-89","type":"NDC"}],"standard_charges":[{"gross_charge":16.68,"discounted_cash":8.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG ORAL CHEW","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"00093-2272-34","type":"NDC"}],"standard_charges":[{"gross_charge":16.43,"discounted_cash":8.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00338-0553-18","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00409-7101-67","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEL DRESSING 4 X 4 \" TOP BNDG","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"53303-0141-41","type":"NDC"}],"standard_charges":[{"gross_charge":16.25,"discounted_cash":8.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE  10 MG ORAL TR12","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"59011-0410-20","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000-0.1 UNIT/GRAM-% TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"62332-0585-15","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALISKIREN 150 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"66993-0141-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.58,"discounted_cash":8.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBETASOL 0.05 % TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"69238-1532-05","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIKACIN 1000 MG/4 ML INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"23155-0290-32","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIKACIN 1000 MG/4 ML INJ SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0278","type":"HCPCS"},{"code":"23155-0290-42","type":"NDC"}],"standard_charges":[{"gross_charge":16.74,"discounted_cash":8.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.4 MG/ML IV SOLN ORDERABLE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-0401-25","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.4 MG/ML IV SOLN ORDERABLE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-1004-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 30 MG/30 ML PCA - OPIOID TOLERANT","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00000-0039-08","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 30 MG/30 ML PCA - PEDS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00000-0039-08","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 30 MG/30 ML PCA STEP 2","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00000-0039-08","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"00143-9141-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE 250 MG/20 ML (12.5 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"00143-9141-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.72,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL 10 MG/ML IV SOLUTION - NICU","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"55150-0194-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL 100 MG/10 ML (10 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"55150-0194-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.4,"discounted_cash":8.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-0213-01","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML FOR GLUCOMMANDER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8215-17","type":"NDC"}],"standard_charges":[{"gross_charge":16.73,"discounted_cash":8.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUMETANIDE 0.25 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1939","type":"HCPCS"},{"code":"68462-0470-54","type":"NDC"}],"standard_charges":[{"gross_charge":16.36,"discounted_cash":8.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G POTASSIUM  5 MILLION UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"00049-0520-83","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G POTASSIUM  5 MILLION UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"00049-0520-84","type":"NDC"}],"standard_charges":[{"gross_charge":16.78,"discounted_cash":8.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOMIDATE 2 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9507-10","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TMP 1 MG/ML IV CMP - FROM STOCK SOLUTION","drug_information":{"unit":"80","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9997-61","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DRONABINOL  2.5 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"Q0167","type":"HCPCS"},{"code":"60687-0375-21","type":"NDC"}],"standard_charges":[{"gross_charge":16.31,"discounted_cash":8.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0040-70","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZONISAMIDE 10 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0078-75","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FUROSEMIDE 10 MG/ML ORAL SOLN","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00054-3294-46","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 G ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00310-1110-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM ZIRCONIUM CYCLOSILICATE 10 G ORAL PWPK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00310-1110-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.33,"discounted_cash":8.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM HYDROXIDE GEL 320 MG/5 ML ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00536-0091-85","type":"NDC"}],"standard_charges":[{"gross_charge":17.03,"discounted_cash":8.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL 89 % TOP SWAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00884-6297-30","type":"NDC"}],"standard_charges":[{"gross_charge":16.96,"discounted_cash":8.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE PERIPHERAL 0.05 MMOL/ML - FROM NICU STOCK SOLUTION","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9999-17","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYMYXIN B SULF-TRIMETHOPRIM 10,000 UNIT- 1 MG/ML OPHT DROP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"61314-0628-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.12,"discounted_cash":8.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL 300 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"68084-0752-18","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":8.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL 300 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"68084-0752-19","type":"NDC"}],"standard_charges":[{"gross_charge":17.19,"discounted_cash":8.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANTHANUM  500 MG ORAL CHEW","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"68180-0819-42","type":"NDC"}],"standard_charges":[{"gross_charge":17.29,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANTHANUM  500 MG ORAL CHEW","drug_information":{"unit":"45","type":"UN"},"code_information":[{"code":"68180-0819-52","type":"NDC"}],"standard_charges":[{"gross_charge":17.29,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.4 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-1004-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.4 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-1004-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (PF) 0.75 % (7.5 MG/ML) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0172-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE *PF* SYRINGE FOR EYE SURGERY","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"55150-0172-30","type":"NDC"}],"standard_charges":[{"gross_charge":17.28,"discounted_cash":8.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"09999-9999-73","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE IN NACL (ISO-OSM) 400 MG/200 ML IV PGBK","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"25021-0184-87","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 20 MG/100 ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"00143-9719-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 20 MG/100 ML IVPB","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"00143-9719-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 10 MG/ML IV EMUL","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"00409-4699-33","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 10 MG/ML IV INFUSION","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"00409-4699-33","type":"NDC"}],"standard_charges":[{"gross_charge":16.8,"discounted_cash":8.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-3299-05","type":"NDC"}],"standard_charges":[{"gross_charge":17.2,"discounted_cash":8.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML (6.7 MG/5 ML) ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"00000-0071-92","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":8.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOTANE 500 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00015-3080-60","type":"NDC"}],"standard_charges":[{"gross_charge":18.04,"discounted_cash":9.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00409-4887-99","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 70-HYPROMELLOSE 0.1-0.3 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00536-1282-94","type":"NDC"}],"standard_charges":[{"gross_charge":17.46,"discounted_cash":8.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROLAMINE SALICYLATE 10 % TOP CREA","drug_information":{"unit":"85","type":"GR"},"code_information":[{"code":"04116-7057-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.02,"discounted_cash":9.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE-HCTZ 5-5 MG/ML 60 ML","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"09999-9991-61","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE-HCTZ 5-5 MG/ML 60 ML (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"09999-9992-62","type":"NDC"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":9.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOCAINE-MENTHOL 20-0.5 % TOP AERO","drug_information":{"unit":"85","type":"GR"},"code_information":[{"code":"16864-0680-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.36,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 1 % TOP SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"45802-0562-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":8.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM 50 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"50474-0970-75","type":"NDC"}],"standard_charges":[{"gross_charge":18.36,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LATANOPROST 0.005 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"59762-0333-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.24,"discounted_cash":9.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIMOLOL MALEATE 0.5 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0227-05","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"70069-0131-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.28,"discounted_cash":9.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 7 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"09999-9999-87","type":"NDC"}],"standard_charges":[{"gross_charge":17.6,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE CITRATED SYRINGE","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0706","type":"HCPCS"},{"code":"47335-0289-40","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":8.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 150 MG/ML INJ SOLN","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"25021-0115-06","type":"NDC"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":8.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJ FOR PEDS PCA","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"63323-0851-03","type":"NDC"}],"standard_charges":[{"gross_charge":17.48,"discounted_cash":8.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR 100 UNITS/ML PUMP REFILL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8215-17","type":"NDC"}],"standard_charges":[{"gross_charge":18.09,"discounted_cash":9.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 100 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"00641-6217-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 100 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"00641-6217-25","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOCARBAMOL 100 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2800","type":"HCPCS"},{"code":"55150-0223-10","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":8.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 1000 MCG/100 ML (10 MCG/ML) PREMADE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-4270-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.6,"discounted_cash":8.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 1 GRAM/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"63323-0117-01","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 1 GRAM/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"63323-0117-20","type":"NDC"}],"standard_charges":[{"gross_charge":17.92,"discounted_cash":8.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 250 MG ORAL TAB ED ZPAK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"09999-9997-67","type":"NDC"}],"standard_charges":[{"gross_charge":18.17,"discounted_cash":9.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  2 % MM SOLN (UD)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00121-4950-15","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  2 % MM SOLN (UD)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00121-4950-40","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":9.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 5MG/ML SUSPENSION (ANYSIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9997-24","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"09999-9998-18","type":"NDC"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":9.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"09999-9998-19","type":"NDC"}],"standard_charges":[{"gross_charge":18.92,"discounted_cash":9.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % TOP CREA","drug_information":{"unit":"50","type":"GR"},"code_information":[{"code":"43598-0210-55","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":9.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN POLISTIREX 30 MG/5 ML ORAL SU12","drug_information":{"unit":"89","type":"ML"},"code_information":[{"code":"46122-0141-21","type":"NDC"}],"standard_charges":[{"gross_charge":18.52,"discounted_cash":9.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"49502-0605-61","type":"NDC"}],"standard_charges":[{"gross_charge":18.4,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2 ML INHL NEBU","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"49502-0605-95","type":"NDC"}],"standard_charges":[{"gross_charge":18.4,"discounted_cash":9.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM 50 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"50474-0970-63","type":"NDC"}],"standard_charges":[{"gross_charge":18.36,"discounted_cash":9.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUINIDINE GLUCONATE 324 MG ORAL TBER","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"53489-0141-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.74,"discounted_cash":9.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISATRACURIUM 2 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0417-10","type":"NDC"}],"standard_charges":[{"gross_charge":18.88,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0133","type":"HCPCS"},{"code":"63323-0325-20","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME 100 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"09999-9999-75","type":"NDC"}],"standard_charges":[{"gross_charge":19.12,"discounted_cash":9.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9549-24","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9549-50","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GANCICLOVIR 5 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"09999-9999-59","type":"NDC"}],"standard_charges":[{"gross_charge":18.76,"discounted_cash":9.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG - FOR PAIN IVPB","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4903-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG - FOR PAIN IVPB","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"00409-4903-34","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":9.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1178-03","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1178-30","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1253-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1253-11","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":9.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"70095-0024-01","type":"NDC"}],"standard_charges":[{"gross_charge":18.64,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANTOPRAZOLE 40 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2470","type":"HCPCS"},{"code":"70095-0024-02","type":"NDC"}],"standard_charges":[{"gross_charge":18.64,"discounted_cash":9.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0039-28","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0039-30","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0039-32","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0039-33","type":"NDC"}],"standard_charges":[{"gross_charge":18.87,"discounted_cash":9.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0526-06","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 25 MG RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0526-12","type":"NDC"}],"standard_charges":[{"gross_charge":18.6,"discounted_cash":9.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5 ML FOR CONT. NEB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-6993-31","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-6993-31","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5 ML FOR CONT. NEB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-6993-93","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/0.5 ML INHL NEBU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-6993-93","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOTIFEN FUMARATE 0.025 % (0.035 %) OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00536-1252-40","type":"NDC"}],"standard_charges":[{"gross_charge":19.96,"discounted_cash":9.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP POWD","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00574-2008-15","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLCELLULOSE (WITH SUGAR) 2 GRAM/19 GRAM ORAL POWD","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"00904-5675-16","type":"NDC"}],"standard_charges":[{"gross_charge":19.98,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID 0.25 % IR SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-6143-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MULTIVIT-MIN-FERROUS GLUCONATE  9 MG IRON/15 ML ORAL LIQD","drug_information":{"unit":"236","type":"ML"},"code_information":[{"code":"06961-8008-58","type":"NDC"}],"standard_charges":[{"gross_charge":19.83,"discounted_cash":9.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOPIDOGREL BISULFATE 5MG/ML SUSPENSION 120 ML BULK","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9997-23","type":"NDC"}],"standard_charges":[{"gross_charge":19.2,"discounted_cash":9.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 200 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"52244-0200-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":9.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 15 MG/ML (1.5 %) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0493-97","type":"NDC"}],"standard_charges":[{"gross_charge":19.44,"discounted_cash":9.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7336-04","type":"NDC"}],"standard_charges":[{"gross_charge":19.51,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE   2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"00409-7336-11","type":"NDC"}],"standard_charges":[{"gross_charge":19.51,"discounted_cash":9.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE)  1000 UNITS/ML INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"63323-0540-36","type":"NDC"}],"standard_charges":[{"gross_charge":19.68,"discounted_cash":9.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-31","type":"NDC"}],"standard_charges":[{"gross_charge":19.36,"discounted_cash":9.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1000 MG IV SOLR","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"25021-0151-20","type":"NDC"}],"standard_charges":[{"gross_charge":19.38,"discounted_cash":9.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 0.2 MEQ/ML SYRINGE BOLUS - NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00000-0099-97","type":"NDC"}],"standard_charges":[{"gross_charge":19.4,"discounted_cash":9.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN WATER 20 MEQ/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7075-26","type":"NDC"}],"standard_charges":[{"gross_charge":19.6,"discounted_cash":9.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SYRP 5 ML","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00000-0060-96","type":"NDC"}],"standard_charges":[{"gross_charge":19.42,"discounted_cash":9.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"00143-9245-01","type":"NDC"}],"standard_charges":[{"gross_charge":19.76,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACARBAZINE 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"00143-9245-10","type":"NDC"}],"standard_charges":[{"gross_charge":19.76,"discounted_cash":9.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 50 MG/10 ML (5 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"60505-6132-06","type":"NDC"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5 ML ORAL LIQD","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0058-61","type":"NDC"}],"standard_charges":[{"gross_charge":20.38,"discounted_cash":10.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 2.5 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0063-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.31,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 %-LACTATED RINGERS IR SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00409-7929-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 1,000-62.5 MG ORAL TB12","drug_information":{"unit":"40","type":"UN"},"code_information":[{"code":"00781-1943-39","type":"NDC"}],"standard_charges":[{"gross_charge":20.36,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELECTROLYTE-R (PH 7.4) IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7670-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % 0.45 % IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7985-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7985-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN IN 0.225 % NACL 300 MG/5 ML INHL NEBU","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"42571-0408-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.06,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN IN 0.225 % NACL 300 MG/5 ML INHL NEBU","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"42571-0408-92","type":"NDC"}],"standard_charges":[{"gross_charge":20.06,"discounted_cash":10.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM 30 MG AMPICILLIN/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"67","type":"ML"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"09999-9999-82","type":"NDC"}],"standard_charges":[{"gross_charge":20.37,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"00409-9735-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"00409-9735-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"60505-6147-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFEPIME   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0692","type":"HCPCS"},{"code":"60505-6147-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.2,"discounted_cash":10.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN  80 MG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0112-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":10.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM NICU STOCK SOLUTION","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9999-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM PEDS STOCK SOLUTION","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9999-31","type":"NDC"}],"standard_charges":[{"gross_charge":20.34,"discounted_cash":10.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 1 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"09999-9990-28","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":10.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1000 MG/250 ML NS IVPB","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00000-0048-61","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 20 GRAM/500 ML (4 %) IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"00409-2050-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE IN WATER 20 GRAM/500 ML (4 %) IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"00409-2050-20","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0642-20","type":"NDC"}],"standard_charges":[{"gross_charge":20.08,"discounted_cash":10.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP - PEDIATRIC","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"00990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"00990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% (IN ML/KG)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"00990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP - FOR ARTERIAL LINE / DILUTION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"00990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00264-7750-00","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5%-0.2 % SOD CHLORIDE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7924-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 %-0.45 % SODIUM CHLORIDE IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7926-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) IV SOLP (WEIGHT BASED)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-09","type":"NDC"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":10.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TPN NICU STARTER -  SPLIT ADMINISTRATION","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"00000-0000-21","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TPN NICU STARTER 150 ML BAG STEP 2","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"00000-0000-21","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00000-0039-94","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARTEMETHER-LUMEFANTRINE 20-120 MG ORAL TAB","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"00078-0568-45","type":"NDC"}],"standard_charges":[{"gross_charge":20.93,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCHLOROSENE SODIUM TOP SOLR","drug_information":{"unit":"2","type":"GR"},"code_information":[{"code":"00327-0001-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.88,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POSACONAZOLE 100 MG ORAL TBEC","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00527-2133-35","type":"NDC"}],"standard_charges":[{"gross_charge":21.16,"discounted_cash":10.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 81 % (W/W) ORAL POWD","drug_information":{"unit":"148","type":"GR"},"code_information":[{"code":"32909-0105-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.72,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 105 % (W/V) ORAL SUSP BTL","drug_information":{"unit":"750","type":"ML"},"code_information":[{"code":"32909-0167-55","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSEUDOEPHEDRINE HCL 15 MG/5 ML ORAL LIQD","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"50580-0536-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"51754-5001-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 1 MEQ/ML (8.4 %) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"51754-5001-04","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0689","type":"HCPCS"},{"code":"00338-3503-41","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFOXITIN   2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0694","type":"HCPCS"},{"code":"44567-0246-25","type":"NDC"}],"standard_charges":[{"gross_charge":20.43,"discounted_cash":10.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5092-11","type":"NDC"}],"standard_charges":[{"gross_charge":20.46,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5092-16","type":"NDC"}],"standard_charges":[{"gross_charge":20.46,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJ FOR PEDS PCA","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"63323-0851-10","type":"NDC"}],"standard_charges":[{"gross_charge":20.98,"discounted_cash":10.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"63323-0288-07","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"63323-0288-21","type":"NDC"}],"standard_charges":[{"gross_charge":20.4,"discounted_cash":10.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 10 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"32","type":"ML"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"09999-9999-14","type":"NDC"}],"standard_charges":[{"gross_charge":20.87,"discounted_cash":10.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% FOR FLUSHING POST ALTEPLASE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00409-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% FOR LINE CARE - 250 ML BAG","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00990-7983-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.0,"discounted_cash":10.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMOZOLOMIDE 100 MG ORAL CAP","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"J8700","type":"HCPCS"},{"code":"67877-0539-14","type":"NDC"}],"standard_charges":[{"gross_charge":20.47,"discounted_cash":10.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE 1 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"61703-0309-06","type":"NDC"}],"standard_charges":[{"gross_charge":21.08,"discounted_cash":10.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE DYE-FREE HCL 12.5 MG/5 ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"09999-9997-35","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE DYE-FREE HCL 12.5 MG/5 ML ORAL LIQD (BULK)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"46122-0685-26","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE DYE-FREE HCL 12.5 MG/5 ML ORAL LIQD (BULK)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"Q0163","type":"HCPCS"},{"code":"50580-0535-01","type":"NDC"}],"standard_charges":[{"gross_charge":20.77,"discounted_cash":10.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"09999-9999-60","type":"NDC"}],"standard_charges":[{"gross_charge":20.96,"discounted_cash":10.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5 ML SUSP 15 ML ED PACK","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0044-03","type":"NDC"}],"standard_charges":[{"gross_charge":21.18,"discounted_cash":10.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) MISC SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00517-7504-25","type":"NDC"}],"standard_charges":[{"gross_charge":21.92,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM METABISULFITE (BULK) 100 % MISC GRAN","drug_information":{"unit":"0.075","type":"GR"},"code_information":[{"code":"05155-2006-99","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM 41 % (AQUAPHOR) OINTMENT","drug_information":{"unit":"50","type":"GR"},"code_information":[{"code":"07214-0452-31","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100,000-0.1 UNIT/G-% TOP CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"45802-0880-94","type":"NDC"}],"standard_charges":[{"gross_charge":21.24,"discounted_cash":10.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC 0.5 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0126-05","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOP CREA","drug_information":{"unit":"80","type":"GR"},"code_information":[{"code":"67877-0251-80","type":"NDC"}],"standard_charges":[{"gross_charge":22.08,"discounted_cash":11.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE 0.2 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0233-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIAGABINE 12 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"72205-0086-30","type":"NDC"}],"standard_charges":[{"gross_charge":21.9,"discounted_cash":10.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  10 MG/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0131","type":"HCPCS"},{"code":"24201-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN  10 MG/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0131","type":"HCPCS"},{"code":"24201-0100-24","type":"NDC"}],"standard_charges":[{"gross_charge":21.2,"discounted_cash":10.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 10 MCG/ML SYRINGES - OSM FOR CODE NARRATOR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"09999-9998-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 30 MG/ML IV SYRINGE - DOSES UNDER 500MG FROM STOCK SOLUTION","drug_information":{"unit":"134","type":"ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"09999-9999-13","type":"NDC"}],"standard_charges":[{"gross_charge":21.98,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN 30 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"134","type":"ML"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"09999-9999-13","type":"NDC"}],"standard_charges":[{"gross_charge":21.98,"discounted_cash":10.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG/250 ML IVPB - CMP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"09999-9997-26","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 200 MCG/ML INFUSION - NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"55150-0287-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILRINONE 200 MCG/ML INFUSION - NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2260","type":"HCPCS"},{"code":"55150-0287-10","type":"NDC"}],"standard_charges":[{"gross_charge":21.6,"discounted_cash":10.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  2.25 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3374-02","type":"NDC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  2.25 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3374-11","type":"NDC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":10.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE-CH PEDS STOCK SOLUTION","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9998-32","type":"NDC"}],"standard_charges":[{"gross_charge":21.42,"discounted_cash":10.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXACILLIN 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J2700","type":"HCPCS"},{"code":"09999-9999-37","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":10.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1250 MG/250 ML NS IVPB","drug_information":{"unit":"1250","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00000-0048-57","type":"NDC"}],"standard_charges":[{"gross_charge":22.0,"discounted_cash":11.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRILAT 0.025 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9999-66","type":"NDC"}],"standard_charges":[{"gross_charge":21.8,"discounted_cash":10.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN   2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"55150-0123-15","type":"NDC"}],"standard_charges":[{"gross_charge":21.7,"discounted_cash":10.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIROLIMUS 1 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"J7520","type":"HCPCS"},{"code":"55111-0653-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.22,"discounted_cash":10.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 100 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"60505-6128-01","type":"NDC"}],"standard_charges":[{"gross_charge":21.92,"discounted_cash":10.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0053-81","type":"NDC"}],"standard_charges":[{"gross_charge":22.71,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM 86.5 % TOP OINT","drug_information":{"unit":"71","type":"GR"},"code_information":[{"code":"11701-0083-33","type":"NDC"}],"standard_charges":[{"gross_charge":22.72,"discounted_cash":11.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10,000 UNIT/GRAM OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"24208-0555-55","type":"NDC"}],"standard_charges":[{"gross_charge":22.54,"discounted_cash":11.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"24208-0910-19","type":"NDC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":11.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEMECLOCYCLINE 300 MG ORAL TAB","drug_information":{"unit":"48","type":"UN"},"code_information":[{"code":"42806-0144-48","type":"NDC"}],"standard_charges":[{"gross_charge":22.45,"discounted_cash":11.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 1 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0121-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.26,"discounted_cash":11.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATRACURIUM 10 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"71288-0701-05","type":"NDC"}],"standard_charges":[{"gross_charge":22.78,"discounted_cash":11.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"00409-2987-03","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM  3 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"00409-2987-23","type":"NDC"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":11.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0260-37","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":11.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9553-24","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0737","type":"HCPCS"},{"code":"00338-9553-50","type":"NDC"}],"standard_charges":[{"gross_charge":22.2,"discounted_cash":11.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 2 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1450","type":"HCPCS"},{"code":"00000-0064-81","type":"NDC"}],"standard_charges":[{"gross_charge":22.4,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 1 MG/ML SYRINGE - NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"09999-9999-55","type":"NDC"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0487-17","type":"NDC"}],"standard_charges":[{"gross_charge":23.12,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  25 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1176-03","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  25 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1176-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1180-59","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 100 MG/ML FOR TOLERANT PCA","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1180-59","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF) 100 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1180-69","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 100 MG/ML FOR TOLERANT PCA","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1180-69","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":11.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM 20 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J2185","type":"HCPCS"},{"code":"09999-9999-45","type":"NDC"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":11.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL (PF)-BUPIVACAINE-NACL 2 MCG/ML- 0.125 % INJ SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"09999-9910-18","type":"NDC"}],"standard_charges":[{"gross_charge":22.4,"discounted_cash":11.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"63323-0967-30","type":"NDC"}],"standard_charges":[{"gross_charge":22.32,"discounted_cash":11.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID 4 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"55111-0685-07","type":"NDC"}],"standard_charges":[{"gross_charge":22.8,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 125 MG/125 ML INFUSION KIT","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00000-0048-43","type":"NDC"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9783-01","type":"NDC"}],"standard_charges":[{"gross_charge":22.52,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUMAZENIL 0.1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9783-10","type":"NDC"}],"standard_charges":[{"gross_charge":22.52,"discounted_cash":11.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SOLR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-47","type":"NDC"}],"standard_charges":[{"gross_charge":23.2,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 250 MG TABLET #21 ED PACK","drug_information":{"unit":"21","type":"UN"},"code_information":[{"code":"00000-0045-41","type":"NDC"}],"standard_charges":[{"gross_charge":23.78,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRANTEL PAMOATE 50 MG/ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0086-74","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 125 MG/5 ML ORAL SOLR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00093-4125-73","type":"NDC"}],"standard_charges":[{"gross_charge":23.2,"discounted_cash":11.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE-SOD CITRATE-CITRIC AC 2.45-2.2 GRAM- 730 MG/100 ML MISC SOLN","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00942-0641-04","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS FOR IRRIGATION","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRANTEL PAMOATE 50 MG/ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"02351-3618-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.52,"discounted_cash":11.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM-ZINC (ILEX) PASTE","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"08212-4271-81","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"discounted_cash":11.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOCAINE 10 % MM GEL","drug_information":{"unit":"7","type":"GR"},"code_information":[{"code":"50486-0550-32","type":"NDC"}],"standard_charges":[{"gross_charge":23.55,"discounted_cash":11.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 300 MG ORAL CP24","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"52244-0300-10","type":"NDC"}],"standard_charges":[{"gross_charge":23.97,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE IN SOD CHLOR,ISO 1 MG/10 ML (100 MCG/ML) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"69374-0925-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 2 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"09999-9998-99","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 2 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"09999-9998-99","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-70","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"63323-0349-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.15,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"63323-0349-25","type":"NDC"}],"standard_charges":[{"gross_charge":23.15,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"70121-1574-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.34,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1010","type":"HCPCS"},{"code":"70121-1574-05","type":"NDC"}],"standard_charges":[{"gross_charge":23.34,"discounted_cash":11.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"00409-3178-02","type":"NDC"}],"standard_charges":[{"gross_charge":23.16,"discounted_cash":11.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1178-03","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":11.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE (PF)  50 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1178-30","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":11.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 % AND 0.9 % SODIUM CHLORIDE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7042","type":"HCPCS"},{"code":"00990-7941-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS FOR LINE CARE","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTATED RINGERS IV (WEIGHT BASED)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7120","type":"HCPCS"},{"code":"00990-7953-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D5 %-0.45 % SODIUM CHLORIDE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7926-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) 10 % IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 10 % IN WATER (D10W) IV SOLP BOLUS","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7930-09","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 40 MG/1 ML FOR DESENSITIZATION","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"00143-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 40 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"00143-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":23.96,"discounted_cash":11.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVOFLURANE INHL LIQD","drug_information":{"unit":"24","type":"ML"},"code_information":[{"code":"00000-0052-25","type":"NDC"}],"standard_charges":[{"gross_charge":24.2,"discounted_cash":12.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"00000-0056-81","type":"NDC"}],"standard_charges":[{"gross_charge":24.9,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  25 MCG/HR TD PT72","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9121-16","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  25 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00378-9121-98","type":"NDC"}],"standard_charges":[{"gross_charge":24.8,"discounted_cash":12.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 0.1 % TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00713-0683-15","type":"NDC"}],"standard_charges":[{"gross_charge":24.84,"discounted_cash":12.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"00781-6139-57","type":"NDC"}],"standard_charges":[{"gross_charge":24.9,"discounted_cash":12.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR IRRIGATION, STERILE IR SOLN","drug_information":{"unit":"1500","type":"ML"},"code_information":[{"code":"00990-7139-36","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL ELIX","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"05483-8001-80","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"45802-0580-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.78,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SCOPOLAMINE BASE 1 MG OVER 3 DAYS TD PT3D","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"45802-0580-46","type":"NDC"}],"standard_charges":[{"gross_charge":24.78,"discounted_cash":12.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 500 MG ORAL TBEC","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"52536-0186-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.02,"discounted_cash":12.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE  15 MG ORAL TR12","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"59011-0415-20","type":"NDC"}],"standard_charges":[{"gross_charge":24.62,"discounted_cash":12.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 100 MG/5 ML (2 %) IV SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"76329-3390-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE-SOD CL,ISO(PF) 20 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"69374-0300-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10 ML (20 MG/ML) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0330","type":"HCPCS"},{"code":"71266-2001-02","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE FOR DESENSITIZATION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-70","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":12.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILISTATIN 5 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"09999-9999-53","type":"NDC"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 4 MG/ML (0.4 %) IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J2002","type":"HCPCS"},{"code":"00338-0409-03","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1500 MG/250 ML NS IVPB","drug_information":{"unit":"1500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00000-0048-58","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 2000 MG/500 ML NS IVPB","drug_information":{"unit":"2000","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00000-0048-62","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IRRIGATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0362-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.92,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0362-01","type":"NDC"}],"standard_charges":[{"gross_charge":24.36,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IRRIGATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0362-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.92,"discounted_cash":12.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 400-80 MG/5 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70069-0362-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.36,"discounted_cash":12.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 3 % HYPERTONIC 3 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7131","type":"HCPCS"},{"code":"00264-7805-10","type":"NDC"}],"standard_charges":[{"gross_charge":24.0,"discounted_cash":12.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 0.3 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00046-1100-81","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 0.45 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00046-1101-81","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 0.625 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00046-1102-81","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 0.9 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00046-1103-81","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS  1.25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00046-1104-81","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00168-0258-15","type":"NDC"}],"standard_charges":[{"gross_charge":25.08,"discounted_cash":12.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"00713-0678-31","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG/5 ML ORAL LIQD","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"06961-8018-54","type":"NDC"}],"standard_charges":[{"gross_charge":25.44,"discounted_cash":12.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE   0.1 % ORAL SUSP 450 ML BTL","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"32909-0927-03","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EDETATE DISODIUM (BULK) 100 % MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"38779-2687-04","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELENIUM SULFIDE 2.5 % TOP LOTN","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"45802-0040-64","type":"NDC"}],"standard_charges":[{"gross_charge":25.44,"discounted_cash":12.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN  2.5 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50458-0577-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.34,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN  2.5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0577-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.34,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0656-05","type":"NDC"}],"standard_charges":[{"gross_charge":25.32,"discounted_cash":12.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL  1 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0595","type":"HCPCS"},{"code":"00409-1623-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.76,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL  1 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0595","type":"HCPCS"},{"code":"00409-1623-21","type":"NDC"}],"standard_charges":[{"gross_charge":25.76,"discounted_cash":12.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0294-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.12,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0294-27","type":"NDC"}],"standard_charges":[{"gross_charge":25.12,"discounted_cash":12.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL DECANOATE  50 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"71288-0502-01","type":"NDC"}],"standard_charges":[{"gross_charge":25.64,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL DECANOATE  50 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"71288-0502-02","type":"NDC"}],"standard_charges":[{"gross_charge":25.64,"discounted_cash":12.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 100 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0113-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.05,"discounted_cash":12.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX CUSTOM DOSE SUBQ SYRINGE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0230-00","type":"NDC"}],"standard_charges":[{"gross_charge":25.24,"discounted_cash":12.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX CUSTOM DOSE SUBQ SYRINGE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0230-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.24,"discounted_cash":12.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 0.1 MG/ML SYRINGE - NICU STEP 2","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"09999-9999-40","type":"NDC"}],"standard_charges":[{"gross_charge":25.6,"discounted_cash":12.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODIXANOL 320 MG IODINE/ML IV SOLN 100 ML BTL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"65219-0383-10","type":"NDC"}],"standard_charges":[{"gross_charge":25.2,"discounted_cash":12.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WHITE PETROLATUM-MINERAL OIL 94-3 % OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"00065-0518-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.69,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPROMELLOSE 0.3 % OPHT GEL","drug_information":{"unit":"10","type":"GR"},"code_information":[{"code":"00065-8064-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.68,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINONIDE 0.05 % TOP CREA","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00093-0262-15","type":"NDC"}],"standard_charges":[{"gross_charge":26.46,"discounted_cash":13.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.1 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00591-3508-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.14,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.1 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00591-3508-54","type":"NDC"}],"standard_charges":[{"gross_charge":26.14,"discounted_cash":13.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 4 X 10 \"-YARD TOP BNDG","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"01678-4345-63","type":"NDC"}],"standard_charges":[{"gross_charge":26.16,"discounted_cash":13.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % TOP OINT","drug_information":{"unit":"80","type":"GR"},"code_information":[{"code":"21922-0063-15","type":"NDC"}],"standard_charges":[{"gross_charge":26.56,"discounted_cash":13.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE HCL (BULK) MISC POWD","drug_information":{"unit":"0.5","type":"GR"},"code_information":[{"code":"51552-0269-09","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":13.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 0.1 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"61314-0014-25","type":"NDC"}],"standard_charges":[{"gross_charge":26.02,"discounted_cash":13.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERMETHRIN 1 % TOP LIQD","drug_information":{"unit":"59","type":"ML"},"code_information":[{"code":"63736-0024-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.67,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFABUTIN 150 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70954-0041-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":13.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP OINT","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"72578-0089-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.4,"discounted_cash":13.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN  5 ML VIAL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"00270-1111-04","type":"NDC"}],"standard_charges":[{"gross_charge":26.76,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71288-0437-91","type":"NDC"}],"standard_charges":[{"gross_charge":26.21,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 120 MG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71288-0437-92","type":"NDC"}],"standard_charges":[{"gross_charge":26.21,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55111-0678-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.21,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 2.5 MG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55111-0678-11","type":"NDC"}],"standard_charges":[{"gross_charge":26.21,"discounted_cash":13.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 20 MG/4 ML (5 MG/ML) IV SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"00409-2339-24","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 20 MG/4 ML (5 MG/ML) IV SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1920","type":"HCPCS"},{"code":"00409-2339-34","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0481-01","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":13.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0481-57","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":13.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 1750 MG/250 ML NS IVPB","drug_information":{"unit":"1750","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"00000-0048-59","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":13.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-4346-16","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-4346-73","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 50 MG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0001-00","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":13.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 50 MG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0001-10","type":"NDC"}],"standard_charges":[{"gross_charge":26.2,"discounted_cash":13.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCHLORPERAZINE 25 MG RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00574-7226-12","type":"NDC"}],"standard_charges":[{"gross_charge":26.51,"discounted_cash":13.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 125 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-21","type":"NDC"}],"standard_charges":[{"gross_charge":27.2,"discounted_cash":13.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STAVUDINE 20 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00003-1965-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.04,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00093-4175-73","type":"NDC"}],"standard_charges":[{"gross_charge":27.2,"discounted_cash":13.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TICAGRELOR 90 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00186-0777-39","type":"NDC"}],"standard_charges":[{"gross_charge":27.89,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETONE MISC LIQD","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00395-0019-94","type":"NDC"}],"standard_charges":[{"gross_charge":26.88,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOIN-ALOE VERA-STORAX-TOLU 10-2-8-4 % TOP TINC","drug_information":{"unit":"59","type":"ML"},"code_information":[{"code":"00395-0243-92","type":"NDC"}],"standard_charges":[{"gross_charge":27.62,"discounted_cash":13.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00406-8003-30","type":"NDC"}],"standard_charges":[{"gross_charge":26.88,"discounted_cash":13.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00409-1749-29","type":"NDC"}],"standard_charges":[{"gross_charge":27.12,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIMETHICONE-COLLOIDAL OATMEAL 1.25 % TOP LOTN","drug_information":{"unit":"354","type":"ML"},"code_information":[{"code":"08137-0036-00","type":"NDC"}],"standard_charges":[{"gross_charge":26.91,"discounted_cash":13.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5 MG/G-10,000 UNIT/G-0.1 % OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"24208-0795-35","type":"NDC"}],"standard_charges":[{"gross_charge":27.0,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRP - BULK BOTTLE","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"57896-0472-08","type":"NDC"}],"standard_charges":[{"gross_charge":27.5,"discounted_cash":13.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 500 MG IN 250 ML OF NS IVPB VM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0456","type":"HCPCS"},{"code":"00000-0077-18","type":"NDC"}],"standard_charges":[{"gross_charge":27.66,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 1 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 1 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"00517-1001-25","type":"NDC"}],"standard_charges":[{"gross_charge":27.88,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"71288-0503-01","type":"NDC"}],"standard_charges":[{"gross_charge":27.14,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1631","type":"HCPCS"},{"code":"71288-0503-02","type":"NDC"}],"standard_charges":[{"gross_charge":27.14,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"00409-4520-02","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN (PORCINE) IN 5 % DEX 25,000 UNIT/250 ML(100 UNIT/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"00409-4520-30","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0488-17","type":"NDC"}],"standard_charges":[{"gross_charge":27.52,"discounted_cash":13.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 2 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"09999-9999-47","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"09999-9999-47","type":"NDC"}],"standard_charges":[{"gross_charge":27.6,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL (PF)-BUPIVACAINE-NACL 2 MCG/ML- 0.125 % INJ SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"09999-9910-19","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL (PF)-BUPIVACAINE-NACL 2 MCG/ML- 0.125 % INJ SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"70092-1105-37","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.45% WITH KCL 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-9257-39","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00338-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 %-LACTATED RINGERS IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7121","type":"HCPCS"},{"code":"00990-7929-09","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0057-62","type":"NDC"}],"standard_charges":[{"gross_charge":28.4,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"00000-0088-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.44,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR  6 MG/ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0107-68","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":14.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STAVUDINE 30 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00003-1966-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.72,"discounted_cash":14.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STAVUDINE 40 MG ORAL CAP","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00003-1967-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPHAZOLINE-PHENIRAMINE 0.025-0.3 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00065-0085-15","type":"NDC"}],"standard_charges":[{"gross_charge":29.22,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN V POTASSIUM 250 MG/5 ML ORAL SOLR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00093-4127-73","type":"NDC"}],"standard_charges":[{"gross_charge":28.4,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYDROXIDE (BULK) 100 % MISC PLLT","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"05155-2008-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OSELTAMIVIR  6 MG/ML ORAL SUSR","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"27241-0139-09","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":14.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE PROPIONATE  50 MCG/ACTUATION NASL SPSN","drug_information":{"unit":"16","type":"GR"},"code_information":[{"code":"60505-0829-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.19,"discounted_cash":14.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE  5 % TOP OINT","drug_information":{"unit":"35.44","type":"GR"},"code_information":[{"code":"68462-0418-20","type":"NDC"}],"standard_charges":[{"gross_charge":28.22,"discounted_cash":14.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SENNOSIDES 8.8 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"71399-8237-08","type":"NDC"}],"standard_charges":[{"gross_charge":28.44,"discounted_cash":14.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLINE 500 MG/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0280","type":"HCPCS"},{"code":"00409-5922-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.44,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"72266-0127-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":14.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0500","type":"HCPCS"},{"code":"72266-0127-05","type":"NDC"}],"standard_charges":[{"gross_charge":29.26,"discounted_cash":14.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00781-3288-09","type":"NDC"}],"standard_charges":[{"gross_charge":29.4,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00781-3288-91","type":"NDC"}],"standard_charges":[{"gross_charge":29.4,"discounted_cash":14.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.5 MG/ML SUSPENSION 30 ML (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"00000-0002-67","type":"NDC"}],"standard_charges":[{"gross_charge":28.32,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCOPYRROLATE 0.5 MG/ML SUSPENSION 30 ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1596","type":"HCPCS"},{"code":"09999-9991-67","type":"NDC"}],"standard_charges":[{"gross_charge":28.32,"discounted_cash":14.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1790","type":"HCPCS"},{"code":"00517-9702-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":14.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DROPERIDOL 2.5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1790","type":"HCPCS"},{"code":"00517-9702-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":14.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE 10 MG/ML INJ CRTG - OPIOID TOLERANT","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-6030-04","type":"NDC"}],"standard_charges":[{"gross_charge":28.2,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF)  0.5 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"00409-3814-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.12,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF)  0.5 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"00409-3814-12","type":"NDC"}],"standard_charges":[{"gross_charge":29.12,"discounted_cash":14.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM FERRIC GLUCONAT-SUCROSE 62.5 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2916","type":"HCPCS"},{"code":"00143-9570-01","type":"NDC"}],"standard_charges":[{"gross_charge":28.84,"discounted_cash":14.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM FERRIC GLUCONAT-SUCROSE 62.5 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2916","type":"HCPCS"},{"code":"00143-9570-10","type":"NDC"}],"standard_charges":[{"gross_charge":28.84,"discounted_cash":14.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0300-03","type":"NDC"}],"standard_charges":[{"gross_charge":28.96,"discounted_cash":14.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCEROL STERILE SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0036-38","type":"NDC"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 1,250 MG (500 MG OF CALCIUM)/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0106-99","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CARBONATE 1,250 MG (500 MG OF CALCIUM)/5 ML ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0766-16","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25 %-1:200,000 INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00409-1746-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.12,"discounted_cash":15.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILNACIPRAN 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00456-1510-60","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILNACIPRAN  25 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00456-1525-60","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MILNACIPRAN  50 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00456-1550-60","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL-MANNITOL-XANTHAN GUM ORAL LIQD","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"01513-7021-27","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 25 MCG/ML ORAL SUSPENSION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9998-03","type":"NDC"}],"standard_charges":[{"gross_charge":29.6,"discounted_cash":14.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLECAINIDE 20 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9998-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROMETHORPHAN-GUAIFENESIN 10-100 MG/5 ML ORAL LIQD","drug_information":{"unit":"236","type":"ML"},"code_information":[{"code":"53076-1189-36","type":"NDC"}],"standard_charges":[{"gross_charge":30.21,"discounted_cash":15.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"65219-0052-29","type":"NDC"}],"standard_charges":[{"gross_charge":29.52,"discounted_cash":14.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"00143-9180-01","type":"NDC"}],"standard_charges":[{"gross_charge":29.68,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"00143-9180-25","type":"NDC"}],"standard_charges":[{"gross_charge":29.68,"discounted_cash":14.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE IN D5W 250 MG/250 ML (1 MG/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"00409-2346-32","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00409-7809-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE IN 5 % DEXTROSE 400 MG/250 ML (1,600 MCG/ML) IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00409-7809-22","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"66794-0219-43","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID IN DEXTROSE 5% 600 MG/300 ML IV PGBK","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J2020","type":"HCPCS"},{"code":"66794-0219-63","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  3.375 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3378-11","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  3.375 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3378-13","type":"NDC"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0047-22","type":"NDC"}],"standard_charges":[{"gross_charge":30.02,"discounted_cash":15.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0047-25","type":"NDC"}],"standard_charges":[{"gross_charge":30.02,"discounted_cash":15.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL PCA 50 MCG/ML FOR SUPPORTIVE CARE INGREDIENT","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-0077-05","type":"NDC"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"64253-0900-30","type":"NDC"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"64253-0900-36","type":"NDC"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN  30 ML BTL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-58","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN  30 ML BTL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-59","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":14.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 100 MG/ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0000-05","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":15.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 125 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0066-52","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CADD CASSETTE -100 ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-2173-02","type":"NDC"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIPASE-PROTEASE-AMYLASE 24,000-76,000 -120,000 UNIT ORAL CPDR","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00032-2636-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.69,"discounted_cash":15.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  10 MG/5 ML ORAL SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00054-0237-49","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":15.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  60 MG ORAL CERP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00591-3452-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.72,"discounted_cash":15.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"57237-0034-50","type":"NDC"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 10 MG/ML ORAL SUSR","drug_information":{"unit":"35","type":"ML"},"code_information":[{"code":"57237-0149-35","type":"NDC"}],"standard_charges":[{"gross_charge":31.64,"discounted_cash":15.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE  20 MG ORAL TR12","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"59011-0420-20","type":"NDC"}],"standard_charges":[{"gross_charge":31.17,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMIVUDINE 100 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"60505-3250-06","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":15.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRANSFER SET-SYRINGE-BAND-TUBE MISC MISC","drug_information":{"unit":"7","type":"UN"},"code_information":[{"code":"60635-0123-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.43,"discounted_cash":15.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICONAZOLE NITRATE 100 MG VAGL SUPP","drug_information":{"unit":"7","type":"UN"},"code_information":[{"code":"61269-0736-07","type":"NDC"}],"standard_charges":[{"gross_charge":30.44,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"70756-0607-30","type":"NDC"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OFLOXACIN 0.3 % OTIC DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"70756-0609-15","type":"NDC"}],"standard_charges":[{"gross_charge":30.28,"discounted_cash":15.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0293-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":15.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0293-37","type":"NDC"}],"standard_charges":[{"gross_charge":30.6,"discounted_cash":15.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0232-00","type":"NDC"}],"standard_charges":[{"gross_charge":30.83,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 7.5 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0232-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.83,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF)  1 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"00409-3815-11","type":"NDC"}],"standard_charges":[{"gross_charge":30.44,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF)  1 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"00409-3815-12","type":"NDC"}],"standard_charges":[{"gross_charge":30.44,"discounted_cash":15.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G 50,000 UNITS/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2540","type":"HCPCS"},{"code":"09999-9999-34","type":"NDC"}],"standard_charges":[{"gross_charge":31.2,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9786-01","type":"NDC"}],"standard_charges":[{"gross_charge":31.17,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENALAPRILAT 1.25 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9786-10","type":"NDC"}],"standard_charges":[{"gross_charge":31.17,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00517-6710-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM CHLORIDE 100 MG/ML (10 %) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00517-6710-10","type":"NDC"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"10019-0953-01","type":"NDC"}],"standard_charges":[{"gross_charge":30.36,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9209","type":"HCPCS"},{"code":"10019-0953-62","type":"NDC"}],"standard_charges":[{"gross_charge":30.36,"discounted_cash":15.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPTOPRIL 1 MG/ML SOLUTION 200 ML (ANY SIZE)","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"00000-0040-26","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 3 MG/ML SUSPENSION 100 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0049-60","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANSOPRAZOLE 3 MG/ML SUSPENSION 100 ML (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0057-37","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 10 MG/ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"35","type":"ML"},"code_information":[{"code":"00000-0071-71","type":"NDC"}],"standard_charges":[{"gross_charge":31.64,"discounted_cash":15.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERROUS SULFATE 220 MG (44 MG IRON)/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0095-03","type":"NDC"}],"standard_charges":[{"gross_charge":32.17,"discounted_cash":16.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOS-METFORMIN 50-500 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00006-0575-61","type":"NDC"}],"standard_charges":[{"gross_charge":32.04,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOS-METFORMIN 50-1,000 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00006-0577-61","type":"NDC"}],"standard_charges":[{"gross_charge":32.04,"discounted_cash":16.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJ ESTROG-MEDROXYPROGEST ACE 0.625-2.5 MG ORAL TAB","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"00046-1107-11","type":"NDC"}],"standard_charges":[{"gross_charge":32.19,"discounted_cash":16.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LOPINAVIR-RITONAVIR 200-50 MG ORAL TAB","drug_information":{"unit":"120","type":"UN"},"code_information":[{"code":"00074-6799-22","type":"NDC"}],"standard_charges":[{"gross_charge":31.81,"discounted_cash":15.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"WATER FOR INJECTION, STERILE IV SOLP","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"00990-7118-07","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM ALGINATE-HONEY 4 X 5 \" TOP BNDG","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"00995-8031-41","type":"NDC"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 100 MG/ML IN SUSPENDIT (PCCA FORMULA AND BASE) 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9991-83","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"discounted_cash":16.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMOTRIGINE 100 MG/ML IN SUSPENDIT (PCCA FORMULA AND BASE) - ANY SIZE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9991-84","type":"NDC"}],"standard_charges":[{"gross_charge":32.4,"discounted_cash":16.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.2 % (W/W) RECTAL OINTMENT (COMPOUNDED)","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"09999-9997-57","type":"NDC"}],"standard_charges":[{"gross_charge":32.52,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOYL PEROXIDE  5 % TOP GEL","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"71399-9478-06","type":"NDC"}],"standard_charges":[{"gross_charge":31.92,"discounted_cash":15.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML (0.1 MMOL/0.2 ML) IV SOLN  5 ML VIAL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"A9577","type":"HCPCS"},{"code":"00270-5164-12","type":"NDC"}],"standard_charges":[{"gross_charge":31.82,"discounted_cash":15.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN(PORCINE) IN 0.45% NACL 25000 UNIT/250 ML IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"63323-0517-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPARIN(PORCINE) IN 0.45% NACL 25000 UNIT/250 ML IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1644","type":"HCPCS"},{"code":"63323-0517-74","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3390-04","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3390-11","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00781-3114-91","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 GRAM INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00781-3114-95","type":"NDC"}],"standard_charges":[{"gross_charge":31.9,"discounted_cash":15.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE 10 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"63323-0229-05","type":"NDC"}],"standard_charges":[{"gross_charge":32.5,"discounted_cash":16.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE-D5-0.9%NACL 40 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7109-09","type":"NDC"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSR","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"00093-2026-23","type":"NDC"}],"standard_charges":[{"gross_charge":32.28,"discounted_cash":16.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT /0.1 ML IDRM SOLN","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"00000-0078-36","type":"NDC"}],"standard_charges":[{"gross_charge":32.68,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCRALFATE 4%/ZINC OXIDE 20% OINTMENT","drug_information":{"unit":"120","type":"GR"},"code_information":[{"code":"00000-0116-07","type":"NDC"}],"standard_charges":[{"gross_charge":32.64,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM BROMIDE 42 MCG (0.06 %) NASL SPRY","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00054-0046-41","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LORAZEPAM 2 MG/ML ORAL CONC","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00054-3532-44","type":"NDC"}],"standard_charges":[{"gross_charge":33.36,"discounted_cash":16.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.25 %-1:200,000 INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-1752-50","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":16.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM ACETATE 2 MEQ/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-3294-51","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC SUBSULFATE 51%","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"44128-0010-08","type":"NDC"}],"standard_charges":[{"gross_charge":33.86,"discounted_cash":16.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.3 MG SL SUBL","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"68462-0638-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":16.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE (PF) 1 MG/ML (1 ML) IM INJECTION","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0173","type":"HCPCS"},{"code":"40811-8405-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":16.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0173","type":"HCPCS"},{"code":"54288-0103-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":16.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0173","type":"HCPCS"},{"code":"54288-0103-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.62,"discounted_cash":16.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.1 MG/ML INJ SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"64253-0400-30","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 0.1 MG/ML INJ SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0461","type":"HCPCS"},{"code":"64253-0400-91","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 2 % INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0296-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPIVACAINE 2 % INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0670","type":"HCPCS"},{"code":"63323-0296-57","type":"NDC"}],"standard_charges":[{"gross_charge":32.6,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML IM SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"67457-0887-00","type":"NDC"}],"standard_charges":[{"gross_charge":32.58,"discounted_cash":16.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML IM SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"67457-0887-01","type":"NDC"}],"standard_charges":[{"gross_charge":32.58,"discounted_cash":16.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM OIL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1071","type":"HCPCS"},{"code":"70700-0289-22","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":16.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 25 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"55150-0183-01","type":"NDC"}],"standard_charges":[{"gross_charge":33.56,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 25 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"55150-0183-10","type":"NDC"}],"standard_charges":[{"gross_charge":33.56,"discounted_cash":16.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROGESTERONE 50 MG/ML IM OIL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2675","type":"HCPCS"},{"code":"63323-0261-10","type":"NDC"}],"standard_charges":[{"gross_charge":32.68,"discounted_cash":16.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPOFOL 10 MG/ML IV INFUSION","drug_information":{"unit":"1000","type":"ME"},"code_information":[{"code":"J2704","type":"HCPCS"},{"code":"00409-4699-24","type":"NDC"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":16.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISONE  5 MG ORAL DSPK","drug_information":{"unit":"21","type":"UN"},"code_information":[{"code":"J7512","type":"HCPCS"},{"code":"70954-0058-30","type":"NDC"}],"standard_charges":[{"gross_charge":33.18,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 20 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"16729-0114-31","type":"NDC"}],"standard_charges":[{"gross_charge":33.08,"discounted_cash":16.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 2.5 GRAM/50 ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"63323-0117-51","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN 100 MG/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"60505-6132-07","type":"NDC"}],"standard_charges":[{"gross_charge":33.12,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DRONABINOL  5 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q0167","type":"HCPCS"},{"code":"60687-0386-11","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DRONABINOL  5 MG ORAL CAP","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"Q0167","type":"HCPCS"},{"code":"60687-0386-94","type":"NDC"}],"standard_charges":[{"gross_charge":33.0,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.5 MG/2 ML INHL NBSP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00487-9701-01","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":17.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORANGE OIL MISC OIL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"06299-1130-61","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 0.5 MG RESPULE FOR ORAL SLURRY","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"09999-9701-99","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":17.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRETINOIN (ANTINEOPLASTIC) 10 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"10370-0268-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.96,"discounted_cash":17.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE 2 % OPHT DROP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"24208-0485-10","type":"NDC"}],"standard_charges":[{"gross_charge":36.32,"discounted_cash":18.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROPICAMIDE 0.5 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"24208-0590-64","type":"NDC"}],"standard_charges":[{"gross_charge":34.74,"discounted_cash":17.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 32 MCG/ACTUATION NASL SPRY (60 SPRAYS)","drug_information":{"unit":"8.43","type":"ML"},"code_information":[{"code":"46122-0389-76","type":"NDC"}],"standard_charges":[{"gross_charge":34.03,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINONIDE 0.05 % TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"51672-1264-01","type":"NDC"}],"standard_charges":[{"gross_charge":35.76,"discounted_cash":17.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0534-36","type":"NDC"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DISULFIRAM 250 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"62135-0431-30","type":"NDC"}],"standard_charges":[{"gross_charge":36.03,"discounted_cash":18.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-11","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN IN 5 % DEXTROSE 900 MG/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0736","type":"HCPCS"},{"code":"00781-3290-09","type":"NDC"}],"standard_charges":[{"gross_charge":35.2,"discounted_cash":17.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2003","type":"HCPCS"},{"code":"55150-0163-30","type":"NDC"}],"standard_charges":[{"gross_charge":36.12,"discounted_cash":18.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100,000 INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0483-57","type":"NDC"}],"standard_charges":[{"gross_charge":35.6,"discounted_cash":17.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0489-17","type":"NDC"}],"standard_charges":[{"gross_charge":35.92,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAMIDRONATE 30 MG/10 ML (3 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2430","type":"HCPCS"},{"code":"67457-0430-10","type":"NDC"}],"standard_charges":[{"gross_charge":34.32,"discounted_cash":17.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"1500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9991-28","type":"NDC"}],"standard_charges":[{"gross_charge":34.8,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"1500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9991-28","type":"NDC"}],"standard_charges":[{"gross_charge":34.8,"discounted_cash":17.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE IN LR-D5 20 MEQ/L IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00990-7111-09","type":"NDC"}],"standard_charges":[{"gross_charge":36.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM ACETATE 2 MEQ/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-3299-06","type":"NDC"}],"standard_charges":[{"gross_charge":34.4,"discounted_cash":17.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-4350-03","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":17.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-4350-13","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":17.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM HCL 5 MG/ML IV SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00641-6015-10","type":"NDC"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":17.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 10 MG/ML SUSPENSION 30 ML (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0002-65","type":"NDC"}],"standard_charges":[{"gross_charge":37.08,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE  6.25 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0039-93","type":"NDC"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN BEADS","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0043-52","type":"NDC"}],"standard_charges":[{"gross_charge":36.45,"discounted_cash":18.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERBUTALINE 5 MG TABLET #6 ED PACK","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00000-0063-32","type":"NDC"}],"standard_charges":[{"gross_charge":37.06,"discounted_cash":18.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG- 10 MCG/ML (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0111-39","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":18.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDIATRIC MULTIVITAMIN NO.192 250 MCG-50 MG- 10 MCG/ML ORAL DROP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00087-0402-03","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":18.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MV NO.189-FERROUS SULFATE 11 MG IRON/ML ORAL DROP","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00087-0405-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":18.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE IN 0.9 % NACL 200 MCG/50 ML (4 MCG/ML) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-1660-50","type":"NDC"}],"standard_charges":[{"gross_charge":37.4,"discounted_cash":18.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE IN 0.9 % NACL 200 MCG/50 ML (4 MCG/ML) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00409-1660-55","type":"NDC"}],"standard_charges":[{"gross_charge":37.4,"discounted_cash":18.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CELECOXIB 10 MG/ML SUSPENSION 30 ML","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9991-65","type":"NDC"}],"standard_charges":[{"gross_charge":37.08,"discounted_cash":18.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDIATRIC MULTIVIT NO.80-IRON 750 UNIT-400 UNIT-10 MG/ML ANY SIZE","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9992-61","type":"NDC"}],"standard_charges":[{"gross_charge":37.0,"discounted_cash":18.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE  6.25 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"27808-0051-02","type":"NDC"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"54643-5649-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":18.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATOVAQUONE 750 MG/5 ML ORAL SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60687-0534-40","type":"NDC"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":18.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZOYL PEROXIDE 10 % TOP GEL","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"71399-9474-06","type":"NDC"}],"standard_charges":[{"gross_charge":37.44,"discounted_cash":18.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 50 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"09999-9999-79","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE FOR DESENSITIZATION","drug_information":{"unit":"75","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9999-11","type":"NDC"}],"standard_charges":[{"gross_charge":36.9,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"44567-0705-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.27,"discounted_cash":18.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"44567-0705-10","type":"NDC"}],"standard_charges":[{"gross_charge":37.27,"discounted_cash":18.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF) 30 MG/30 ML (1 MG/ML) IV PCAS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.32,"discounted_cash":18.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARICALCITOL 5 MCG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2501","type":"HCPCS"},{"code":"00074-1658-01","type":"NDC"}],"standard_charges":[{"gross_charge":37.27,"discounted_cash":18.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE (PF) 100 MG/5 ML (20 MG/ML) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"25021-0229-05","type":"NDC"}],"standard_charges":[{"gross_charge":37.28,"discounted_cash":18.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL 70 % MISC SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-33","type":"NDC"}],"standard_charges":[{"gross_charge":39.74,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL 70% - SMOG RECTAL ENEMA","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-33","type":"NDC"}],"standard_charges":[{"gross_charge":39.74,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.1 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0082-49","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIMODIPINE 30 MG/ML ORAL SOLUTION","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00000-0116-14","type":"NDC"}],"standard_charges":[{"gross_charge":38.8,"discounted_cash":19.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE  5 % OPHT SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00065-0411-30","type":"NDC"}],"standard_charges":[{"gross_charge":38.16,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 100 MG/5 ML ORAL SUSR","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00093-2027-23","type":"NDC"}],"standard_charges":[{"gross_charge":38.58,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTULOSE 10 GRAM/15 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0873-16","type":"NDC"}],"standard_charges":[{"gross_charge":39.74,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOGUANINE 40 MG ORAL TAB","drug_information":{"unit":"25","type":"UN"},"code_information":[{"code":"00173-0880-25","type":"NDC"}],"standard_charges":[{"gross_charge":38.23,"discounted_cash":19.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GREEN SOAP TOP TINC","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"00395-1049-16","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL  12 MG IODINE/ML ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00407-1416-12","type":"NDC"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 15 MG/ML (1.5 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"00409-4776-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.88,"discounted_cash":19.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLERGONOVINE 0.2 MG ORAL TAB","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"70010-0786-28","type":"NDC"}],"standard_charges":[{"gross_charge":38.45,"discounted_cash":19.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  2 % MM SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"72888-0125-26","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":19.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 0.1 MG/ML INJ SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"76329-3318-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":19.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"63323-0322-01","type":"NDC"}],"standard_charges":[{"gross_charge":39.77,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMIPENEM-CILASTATIN 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0743","type":"HCPCS"},{"code":"63323-0322-25","type":"NDC"}],"standard_charges":[{"gross_charge":39.77,"discounted_cash":19.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLISTIN (COLISTIMETHATE NA) 150 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"70594-0023-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":19.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLISTIN (COLISTIMETHATE NA) 150 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"70594-0023-04","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":19.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFEROXAMINE 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0895","type":"HCPCS"},{"code":"60505-6236-06","type":"NDC"}],"standard_charges":[{"gross_charge":38.48,"discounted_cash":19.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0233-00","type":"NDC"}],"standard_charges":[{"gross_charge":39.14,"discounted_cash":19.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 10 MG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55150-0233-10","type":"NDC"}],"standard_charges":[{"gross_charge":39.14,"discounted_cash":19.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100,000 INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0482-57","type":"NDC"}],"standard_charges":[{"gross_charge":38.6,"discounted_cash":19.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3379-04","type":"NDC"}],"standard_charges":[{"gross_charge":38.36,"discounted_cash":19.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM  4.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00409-3379-11","type":"NDC"}],"standard_charges":[{"gross_charge":38.36,"discounted_cash":19.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"68382-0910-01","type":"NDC"}],"standard_charges":[{"gross_charge":38.72,"discounted_cash":19.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE HYCLATE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"68382-0910-10","type":"NDC"}],"standard_charges":[{"gross_charge":38.72,"discounted_cash":19.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINCRISTINE 2 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9370","type":"HCPCS"},{"code":"61703-0309-16","type":"NDC"}],"standard_charges":[{"gross_charge":39.16,"discounted_cash":19.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE 25 MG/ML SUSPENSION 120 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0002-64","type":"NDC"}],"standard_charges":[{"gross_charge":39.84,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"D10 %-0.45 % SODIUM CHLORIDE IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00264-7622-00","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.075 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-3351-16","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.075 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00378-3351-99","type":"NDC"}],"standard_charges":[{"gross_charge":40.5,"discounted_cash":20.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 400 (BULK) MISC LIQD","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"03877-9025-18","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUPPOSITORY BASE NO.55 (BULK) MISC WAX","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"03877-9253-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM SORBATE (BULK) MISC CRYS","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"05155-2021-44","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE 25 MG/ML SUSPENSION 120 ML","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9991-64","type":"NDC"}],"standard_charges":[{"gross_charge":39.84,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TPN ADULT STARTER PRE-PUMPED","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"09999-9999-05","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"39822-1201-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.72,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN B GU 40 MG-200,000 UNIT/ML IR SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"39822-1201-02","type":"NDC"}],"standard_charges":[{"gross_charge":40.72,"discounted_cash":20.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOMETASONE 0.1 % TOP SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"45802-0118-59","type":"NDC"}],"standard_charges":[{"gross_charge":40.32,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (BULK) MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"51552-0145-04","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3412-92","type":"NDC"}],"standard_charges":[{"gross_charge":40.61,"discounted_cash":20.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM 30 MG AMPICILLIN/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"134","type":"ML"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"09999-9992-82","type":"NDC"}],"standard_charges":[{"gross_charge":40.74,"discounted_cash":20.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 150 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"71839-0116-10","type":"NDC"}],"standard_charges":[{"gross_charge":40.33,"discounted_cash":20.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 1 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"80","type":"ML"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"09999-9999-25","type":"NDC"}],"standard_charges":[{"gross_charge":40.64,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP - PEDIATRIC","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP (IN ML/KG/HR)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% (IN ML/KG)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9% IV SOLP - FOR ARTERIAL LINE / DILUTION","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7040","type":"HCPCS"},{"code":"00990-7983-03","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 70 % IN WATER (D70W) IV SOLP","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7120-07","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"00409-0185-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-22","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"URSODIOL 25 MG/ML SUSPENSION 120 ML","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0049-95","type":"NDC"}],"standard_charges":[{"gross_charge":42.24,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"URSODIOL 25 MG/ML SUSPENSION 120 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0057-39","type":"NDC"}],"standard_charges":[{"gross_charge":42.24,"discounted_cash":21.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RILEY BUTT CREAM 100 GRAM JAR","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"00000-0061-41","type":"NDC"}],"standard_charges":[{"gross_charge":41.6,"discounted_cash":20.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 1 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0088-19","type":"NDC"}],"standard_charges":[{"gross_charge":40.92,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETOROLAC (PF) 0.45 % OPHT DPET","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00023-3507-31","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":20.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 24-26 MG ORAL TAB","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"00078-0659-67","type":"NDC"}],"standard_charges":[{"gross_charge":42.31,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 97-103 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00078-0696-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.31,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACUBITRIL-VALSARTAN 49-51 MG ORAL TAB","drug_information":{"unit":"180","type":"UN"},"code_information":[{"code":"00078-0777-67","type":"NDC"}],"standard_charges":[{"gross_charge":42.31,"discounted_cash":21.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00093-4177-73","type":"NDC"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE 1 MG/ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"27808-0002-01","type":"NDC"}],"standard_charges":[{"gross_charge":40.92,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOSAN POLYSULFATE SODIUM 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0098-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.11,"discounted_cash":21.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZELASTINE 137 MCG (0.1 %) NASL SPRY","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"60505-0833-05","type":"NDC"}],"standard_charges":[{"gross_charge":41.52,"discounted_cash":20.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAXIMIN 200 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"65649-0301-03","type":"NDC"}],"standard_charges":[{"gross_charge":40.88,"discounted_cash":20.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOPICLENOL 0.5 MMOL/ML IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"A9573","type":"HCPCS"},{"code":"00270-7020-38","type":"NDC"}],"standard_charges":[{"gross_charge":40.86,"discounted_cash":20.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5093-11","type":"NDC"}],"standard_charges":[{"gross_charge":41.63,"discounted_cash":20.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME   2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"00409-5093-14","type":"NDC"}],"standard_charges":[{"gross_charge":41.63,"discounted_cash":20.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 1 MG/ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00641-6205-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.59,"discounted_cash":20.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 1 MG/ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00641-6205-10","type":"NDC"}],"standard_charges":[{"gross_charge":41.59,"discounted_cash":20.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM BROMIDE 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0475-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.49,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VECURONIUM BROMIDE 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0475-20","type":"NDC"}],"standard_charges":[{"gross_charge":42.49,"discounted_cash":21.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV PGBK","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7050","type":"HCPCS"},{"code":"00409-7101-02","type":"NDC"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":20.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 20 MG/ML (1 ML) IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"25021-0245-01","type":"NDC"}],"standard_charges":[{"gross_charge":41.76,"discounted_cash":20.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMETREXED DISODIUM  100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"71288-0166-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.44,"discounted_cash":21.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE HCL (PF) 0.5 % OPHT DROP","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00065-0741-14","type":"NDC"}],"standard_charges":[{"gross_charge":43.8,"discounted_cash":21.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  50 MCG/HR TD PT72","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9122-16","type":"NDC"}],"standard_charges":[{"gross_charge":43.6,"discounted_cash":21.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  50 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00378-9122-98","type":"NDC"}],"standard_charges":[{"gross_charge":43.6,"discounted_cash":21.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHERRY FLAVOR (BULK) ORAL LIQD","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00395-2662-16","type":"NDC"}],"standard_charges":[{"gross_charge":43.52,"discounted_cash":21.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HONEY  80 % TOP GEL","drug_information":{"unit":"44","type":"ML"},"code_information":[{"code":"00995-8034-71","type":"NDC"}],"standard_charges":[{"gross_charge":42.6,"discounted_cash":21.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PSYLLIUM ORAL POWD","drug_information":{"unit":"300","type":"GR"},"code_information":[{"code":"03848-5808-68","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 32 MCG/ACTUATION NASL SPRY","drug_information":{"unit":"8.43","type":"ML"},"code_information":[{"code":"60505-6129-02","type":"NDC"}],"standard_charges":[{"gross_charge":44.11,"discounted_cash":22.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 4 GRAM/60 ML RECT ENEM","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"62559-0420-07","type":"NDC"}],"standard_charges":[{"gross_charge":44.4,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MESALAMINE 4 GRAM/60 ML RECT ENEM","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"62559-0420-11","type":"NDC"}],"standard_charges":[{"gross_charge":44.4,"discounted_cash":22.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPAGLIFLOZIN PROPANEDIOL 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"66993-0457-30","type":"NDC"}],"standard_charges":[{"gross_charge":44.06,"discounted_cash":22.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROPRUSSIDE 25 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"72485-0105-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.56,"discounted_cash":22.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0137","type":"HCPCS"},{"code":"00143-9386-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN 10 MG/ML SYRINGE - PED/NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0137","type":"HCPCS"},{"code":"00143-9386-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL  1 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1800","type":"HCPCS"},{"code":"63323-0604-01","type":"NDC"}],"standard_charges":[{"gross_charge":42.79,"discounted_cash":21.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNITS/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"43598-0914-06","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VASOPRESSIN 20 UNITS/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2598","type":"HCPCS"},{"code":"43598-0914-11","type":"NDC"}],"standard_charges":[{"gross_charge":43.2,"discounted_cash":21.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 2500 MCG/250 ML SUBQ INFUSION PREMADE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-4270-00","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":21.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 2500 MCG/250 ML SUBQ INFUSION PREMADE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"70092-1093-37","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":21.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 10 MG/ML INJ SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3301","type":"HCPCS"},{"code":"00003-0494-20","type":"NDC"}],"standard_charges":[{"gross_charge":45.08,"discounted_cash":22.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  10 MG/ML SYRINGE NICU","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"42023-0113-10","type":"NDC"}],"standard_charges":[{"gross_charge":42.88,"discounted_cash":21.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 100 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"60505-0134-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.9,"discounted_cash":21.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV - POST PARTUM","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"71019-0253-01","type":"NDC"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":22.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 100 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"00000-0717-00","type":"NDC"}],"standard_charges":[{"gross_charge":42.66,"discounted_cash":21.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 180 MG IODINE/ML IT SOLN 20 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q9965","type":"HCPCS"},{"code":"00407-1411-10","type":"NDC"}],"standard_charges":[{"gross_charge":44.76,"discounted_cash":22.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5 ML SUSP 30 ML ED PACK","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0045-36","type":"NDC"}],"standard_charges":[{"gross_charge":45.96,"discounted_cash":22.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POT & SOD CITRATE-CITRIC ACID 550-500-334 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0086-66","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POT,SODIUM CITRATE-CITRIC ACID 550-500-334 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0677-16","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUNDING VEHICLE SF NO.9 ORAL LIQD","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00395-0094-16","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATRACURIUM 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-1105-02","type":"NDC"}],"standard_charges":[{"gross_charge":45.56,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATRACURIUM 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-1105-22","type":"NDC"}],"standard_charges":[{"gross_charge":45.56,"discounted_cash":22.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRACE ELEMENT PEDI CR-CU-MN-ZN 1 MCG-0.1 MG-25 MCG-1 MG/ML IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"00517-9203-25","type":"NDC"}],"standard_charges":[{"gross_charge":45.23,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTIVATED CHARCOAL 25 GRAM/120 ML ORAL SUSP","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00574-0521-74","type":"NDC"}],"standard_charges":[{"gross_charge":46.56,"discounted_cash":23.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIMPLE SYRUP ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"03172-2937-47","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYPOCHLORITE 0.125 % MISC SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"03932-8064-12","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCROSE (BULK) MISC CRYS","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"05155-2050-25","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":23.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML ORAL SUSP","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"09999-9997-06","type":"NDC"}],"standard_charges":[{"gross_charge":46.56,"discounted_cash":23.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN B-DEXAMETH 3.5MG/ML-10,000 UNIT/ML-0.1 % OPHT DRPS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"24208-0830-60","type":"NDC"}],"standard_charges":[{"gross_charge":45.24,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYPOCHLORITE 0.25 % MISC SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"39328-0063-25","type":"NDC"}],"standard_charges":[{"gross_charge":45.41,"discounted_cash":22.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITS A AND D-WHITE PET-LANOLIN TOP OINT","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"71399-0122-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.4,"discounted_cash":22.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP TC-99M-SOD OXIDRONATE 3.15 MG IV SOLR","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"A9561","type":"HCPCS"},{"code":"69945-0091-20","type":"NDC"}],"standard_charges":[{"gross_charge":46.24,"discounted_cash":23.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLINE 250 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0280","type":"HCPCS"},{"code":"00409-5921-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.68,"discounted_cash":22.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOPHYLLINE 250 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0280","type":"HCPCS"},{"code":"00409-5921-16","type":"NDC"}],"standard_charges":[{"gross_charge":45.68,"discounted_cash":22.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 50 MG/10 ML (5 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"00517-4810-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.24,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 50 MG/10 ML (5 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"00517-4810-25","type":"NDC"}],"standard_charges":[{"gross_charge":45.24,"discounted_cash":22.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3415","type":"HCPCS"},{"code":"63323-0180-00","type":"NDC"}],"standard_charges":[{"gross_charge":45.14,"discounted_cash":22.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOXINE (VITAMIN B6) 100 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3415","type":"HCPCS"},{"code":"63323-0180-01","type":"NDC"}],"standard_charges":[{"gross_charge":45.14,"discounted_cash":22.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE (PF) 2 GRAM/20 ML (100 MG/ML) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"63323-0120-20","type":"NDC"}],"standard_charges":[{"gross_charge":46.4,"discounted_cash":23.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACARBAZINE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9130","type":"HCPCS"},{"code":"63323-0127-10","type":"NDC"}],"standard_charges":[{"gross_charge":45.7,"discounted_cash":22.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 500 MG TABLET #20 ED PACK","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"00000-0029-05","type":"NDC"}],"standard_charges":[{"gross_charge":46.96,"discounted_cash":23.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0088-18","type":"NDC"}],"standard_charges":[{"gross_charge":47.3,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVETIRACETAM 100 MG/ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0799-16","type":"NDC"}],"standard_charges":[{"gross_charge":47.3,"discounted_cash":23.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.05 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-3350-16","type":"NDC"}],"standard_charges":[{"gross_charge":47.34,"discounted_cash":23.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.05 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00378-3350-99","type":"NDC"}],"standard_charges":[{"gross_charge":47.34,"discounted_cash":23.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POVIDONE-IODINE 10 % TOP SOLN","drug_information":{"unit":"236","type":"ML"},"code_information":[{"code":"00904-1103-09","type":"NDC"}],"standard_charges":[{"gross_charge":47.2,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACITRACIN-POLYMYXIN IRRIGATION 500 ML","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"09999-9900-95","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 1000 MCG/250 ML - CMP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"09999-9997-29","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 1000 MCG/250 ML FOR ECMO - CMP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"09999-9997-29","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-BACITRACIN-POLYMYXIN 3.5-400-10,000 MG-UNIT-UNIT/G OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"24208-0780-55","type":"NDC"}],"standard_charges":[{"gross_charge":47.88,"discounted_cash":23.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE  40 % (W/V) ORAL SUSP 240 ML *MULTI-DOSE* BTL","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"32909-0116-00","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG ORAL TAB","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"51862-0564-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.27,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NORGESTREL-ETHINYL ESTRADIOL 0.3-30 MG-MCG ORAL TAB","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"51862-0564-06","type":"NDC"}],"standard_charges":[{"gross_charge":47.27,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"63323-0884-01","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":23.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"63323-0884-06","type":"NDC"}],"standard_charges":[{"gross_charge":47.5,"discounted_cash":23.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90648","type":"HCPCS"},{"code":"49281-0545-03","type":"NDC"}],"standard_charges":[{"gross_charge":47.49,"discounted_cash":23.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HAEMOPH B POLY CONJ-TET TOX-PF 10 MCG/0.5 ML IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90648","type":"HCPCS"},{"code":"49281-0547-58","type":"NDC"}],"standard_charges":[{"gross_charge":47.49,"discounted_cash":23.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-2634-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.47,"discounted_cash":23.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML PUMP","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ SOLN - PUMP REFILL","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML (CPU) - GLUCOMMANDER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9998-75","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ SOLN (CPU)","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9998-75","type":"NDC"}],"standard_charges":[{"gross_charge":47.68,"discounted_cash":23.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REGADENOSON 0.4 MG/5 ML IV SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2785","type":"HCPCS"},{"code":"71288-0201-85","type":"NDC"}],"standard_charges":[{"gross_charge":46.84,"discounted_cash":23.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-7248-03","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HETASTARCH 6 % IN 0.9 % NACL 6 % IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-7248-13","type":"NDC"}],"standard_charges":[{"gross_charge":48.0,"discounted_cash":24.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 10 MG/ML IV SOLN FOR DESENSITIZATION","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"61703-0339-22","type":"NDC"}],"standard_charges":[{"gross_charge":47.64,"discounted_cash":23.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"00069-6001-10","type":"NDC"}],"standard_charges":[{"gross_charge":47.84,"discounted_cash":23.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSPHENYTOIN 500 MG PE/10 ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q2009","type":"HCPCS"},{"code":"00069-6001-21","type":"NDC"}],"standard_charges":[{"gross_charge":47.84,"discounted_cash":23.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOHEXITAL 100 MG/10 ML SYRINGE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0000-58","type":"NDC"}],"standard_charges":[{"gross_charge":50.44,"discounted_cash":25.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0069-71","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DRONEDARONE 400 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00024-4142-60","type":"NDC"}],"standard_charges":[{"gross_charge":48.58,"discounted_cash":24.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION-OLIVE-SOY-LIPID 20 % IV EMUL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00338-9540-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION-OLIVE-SOY-LIPID 20 % IV EMUL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00338-9540-05","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMPAGLIFLOZIN 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00597-0152-37","type":"NDC"}],"standard_charges":[{"gross_charge":50.11,"discounted_cash":25.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARTIFICIAL SALIVA (CMCE-LYTES) MM SPRP","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"05529-9601-04","type":"NDC"}],"standard_charges":[{"gross_charge":48.48,"discounted_cash":24.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 40 MG/ML SUSPENSION 30 ML","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9901-02","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LABETALOL 40 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9901-03","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFADROXIL 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"57237-0097-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.6,"discounted_cash":24.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCYTOSINE 500 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"59651-0332-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.44,"discounted_cash":25.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"63323-0095-61","type":"NDC"}],"standard_charges":[{"gross_charge":50.4,"discounted_cash":25.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 4 % (40 MG/ML) MM SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"64679-0465-51","type":"NDC"}],"standard_charges":[{"gross_charge":49.4,"discounted_cash":24.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSR","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"68180-0657-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.64,"discounted_cash":25.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8803-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8803-59","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH ISOPH 100 UNIT/ML (3ML) SUBQ PEN - GLUCOMMANDER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8805-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8805-01","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH ISOPH 100 UNIT/ML (3ML) SUBQ PEN - GLUCOMMANDER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8805-59","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN NPH ISOPH U-100 HUMAN 100 UNIT/ML (3 ML) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8805-59","type":"NDC"}],"standard_charges":[{"gross_charge":49.88,"discounted_cash":24.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"25021-0190-10","type":"NDC"}],"standard_charges":[{"gross_charge":49.97,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"25021-0190-11","type":"NDC"}],"standard_charges":[{"gross_charge":49.97,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF) IN 0.9 % SOD CHL 1 MG/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"70092-1380-36","type":"NDC"}],"standard_charges":[{"gross_charge":49.2,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLANZAPINE 10 MG IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2359","type":"HCPCS"},{"code":"31722-0308-01","type":"NDC"}],"standard_charges":[{"gross_charge":48.52,"discounted_cash":24.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00409-9094-61","type":"NDC"}],"standard_charges":[{"gross_charge":48.4,"discounted_cash":24.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGNESIUM SULFATE 500 MG/ML (50 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3475","type":"HCPCS"},{"code":"63323-0642-50","type":"NDC"}],"standard_charges":[{"gross_charge":50.2,"discounted_cash":25.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 240 MG IODINE/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00407-1412-33","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 240 MG IODINE/ML IV SOLN 100 ML BTL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00407-1412-33","type":"NDC"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE DIBASIC 3 MILLIMOLE/ML ORAL (ANY SIZE)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0085-40","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0834-09","type":"NDC"}],"standard_charges":[{"gross_charge":52.56,"discounted_cash":26.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 0.1 % TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"00713-0682-15","type":"NDC"}],"standard_charges":[{"gross_charge":51.36,"discounted_cash":25.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXYCYCLINE MONOHYDRATE 25 MG/5 ML ORAL SUSR","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"09999-9997-12","type":"NDC"}],"standard_charges":[{"gross_charge":50.64,"discounted_cash":25.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICLOFENAC SODIUM 0.1 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"24208-0457-05","type":"NDC"}],"standard_charges":[{"gross_charge":52.04,"discounted_cash":26.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-BACITRACIN-POLY-HC 3.5-400-10,000 MG-UNIT/G-1% OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"24208-0785-55","type":"NDC"}],"standard_charges":[{"gross_charge":52.34,"discounted_cash":26.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE-DM 6.25-15 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"27808-0057-01","type":"NDC"}],"standard_charges":[{"gross_charge":51.09,"discounted_cash":25.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 15 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50458-0578-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 15 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0578-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 20 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50458-0579-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 20 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0579-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 10 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50458-0580-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 10 MG ORAL TAB FOR IP VTE PROPHYLAXIS","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50458-0580-01","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 10 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0580-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIVAROXABAN 10 MG ORAL TAB FOR IP VTE PROPHYLAXIS","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50458-0580-10","type":"NDC"}],"standard_charges":[{"gross_charge":50.68,"discounted_cash":25.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20 ML INJECTION","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"25021-0791-20","type":"NDC"}],"standard_charges":[{"gross_charge":51.28,"discounted_cash":25.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 200 MG/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"25021-0791-20","type":"NDC"}],"standard_charges":[{"gross_charge":51.28,"discounted_cash":25.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML SUBQ SOLN - GLUCOMMANDER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":52.65,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00024-5926-05","type":"NDC"}],"standard_charges":[{"gross_charge":52.65,"discounted_cash":26.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 50 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1896-20","type":"NDC"}],"standard_charges":[{"gross_charge":50.88,"discounted_cash":25.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL 10 MG/ML IV SYRINGE - PED/NICU STEP 2","drug_information":{"unit":"3.25","type":"ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"09999-9997-50","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORICONAZOLE 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3465","type":"HCPCS"},{"code":"00049-3190-28","type":"NDC"}],"standard_charges":[{"gross_charge":52.8,"discounted_cash":26.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 1 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"16729-0288-11","type":"NDC"}],"standard_charges":[{"gross_charge":51.8,"discounted_cash":25.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-13","type":"NDC"}],"standard_charges":[{"gross_charge":52.98,"discounted_cash":26.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-61","type":"NDC"}],"standard_charges":[{"gross_charge":52.98,"discounted_cash":26.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML ORAL CONC (ANY SIZE)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0043-64","type":"NDC"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":27.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML ORAL CONC","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00121-0581-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":27.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALPROIC ACID (AS SODIUM SALT) 250 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0675-85","type":"NDC"}],"standard_charges":[{"gross_charge":52.98,"discounted_cash":26.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BROMPHENIRAMINE-PSEUDOEPH-DM 2-30-10 MG/5 ML ORAL SYRP","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00574-1104-04","type":"NDC"}],"standard_charges":[{"gross_charge":52.87,"discounted_cash":26.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BROMPHENIRAMINE-PSEUDOEPH-DM 2-30-10 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"09999-9900-11","type":"NDC"}],"standard_charges":[{"gross_charge":52.87,"discounted_cash":26.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 600-42.9 MG/5 ML ORAL SUSR ED PACK","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"09999-9997-66","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETONE MISC LIQD","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"09999-9997-73","type":"NDC"}],"standard_charges":[{"gross_charge":53.76,"discounted_cash":26.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYBUTYNIN CHLORIDE 5 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"54838-0510-80","type":"NDC"}],"standard_charges":[{"gross_charge":52.98,"discounted_cash":26.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE  40 MG ORAL TR12","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"59011-0440-20","type":"NDC"}],"standard_charges":[{"gross_charge":53.36,"discounted_cash":26.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % DENT PSTE","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"64980-0320-05","type":"NDC"}],"standard_charges":[{"gross_charge":53.08,"discounted_cash":26.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"00270-1111-01","type":"NDC"}],"standard_charges":[{"gross_charge":53.52,"discounted_cash":26.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO-BUPIV RETROBULBAR BLOCK (COMPOUNDED)","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"00000-0001-04","type":"NDC"}],"standard_charges":[{"gross_charge":53.8,"discounted_cash":26.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE (PF) 1,000 MCG/10 ML (100 MCG/ML) EPID SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0735","type":"HCPCS"},{"code":"67457-0218-10","type":"NDC"}],"standard_charges":[{"gross_charge":53.12,"discounted_cash":26.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"73070-0203-15","type":"NDC"}],"standard_charges":[{"gross_charge":54.42,"discounted_cash":27.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE  25 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3230","type":"HCPCS"},{"code":"55150-0318-25","type":"NDC"}],"standard_charges":[{"gross_charge":53.64,"discounted_cash":26.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"76045-0204-00","type":"NDC"}],"standard_charges":[{"gross_charge":53.17,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3360","type":"HCPCS"},{"code":"76045-0204-20","type":"NDC"}],"standard_charges":[{"gross_charge":53.17,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 10 MG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0181-00","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":27.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE 10 MG/ML PEDIATRIC INTRANASAL SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"67457-0181-20","type":"NDC"}],"standard_charges":[{"gross_charge":54.24,"discounted_cash":27.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00000-0039-65","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE 0.5 MG/5 ML ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J8540","type":"HCPCS"},{"code":"00054-3177-63","type":"NDC"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 10 MG/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"61703-0339-22","type":"NDC"}],"standard_charges":[{"gross_charge":53.1,"discounted_cash":26.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL ALCOHOL (BULK) MISC LIQD","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00000-0043-47","type":"NDC"}],"standard_charges":[{"gross_charge":54.72,"discounted_cash":27.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 125 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0073-94","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0078-06","type":"NDC"}],"standard_charges":[{"gross_charge":54.87,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBACHOL 0.01 % IO SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"00065-0023-15","type":"NDC"}],"standard_charges":[{"gross_charge":55.38,"discounted_cash":27.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0854-16","type":"NDC"}],"standard_charges":[{"gross_charge":54.87,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0854-16","type":"NDC"}],"standard_charges":[{"gross_charge":54.87,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.0375 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-3360-16","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.0375 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00378-3360-99","type":"NDC"}],"standard_charges":[{"gross_charge":55.92,"discounted_cash":27.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VEHICLE S 0.2-0.2 % MISC LIQD","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-0307-16","type":"NDC"}],"standard_charges":[{"gross_charge":54.87,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUNDING VEHICLE SYRUP NO15 ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00802-3920-16","type":"NDC"}],"standard_charges":[{"gross_charge":54.87,"discounted_cash":27.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEL NIDO CARDIOPLEGIA - CMP","drug_information":{"unit":"1049.5","type":"ML"},"code_information":[{"code":"09999-9997-36","type":"NDC"}],"standard_charges":[{"gross_charge":54.58,"discounted_cash":27.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9998-93","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERMETHRIN 5 % TOP CREA","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"21922-0021-07","type":"NDC"}],"standard_charges":[{"gross_charge":54.72,"discounted_cash":27.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 100 MG/ML (10 %) MISC SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"63323-0693-10","type":"NDC"}],"standard_charges":[{"gross_charge":54.8,"discounted_cash":27.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"67877-0547-88","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFDINIR 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"67877-0548-88","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML FOR GLUCOMMANDER","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8215-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML FOR GLUCOMMANDER","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00169-1833-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00169-1833-11","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS/ML INJ SOLN (CPU)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9998-74","type":"NDC"}],"standard_charges":[{"gross_charge":55.76,"discounted_cash":27.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA - OPIOID TOLERANT","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9910-17","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA - PEDS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9910-17","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA STEP 2","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9910-17","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA - OPIOID TOLERANT","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA - PEDS","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML PCA STEP 2","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":27.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIPRASIDONE MESYLATE 20 MG/ML (FINAL CONC.) IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3486","type":"HCPCS"},{"code":"43598-0848-58","type":"NDC"}],"standard_charges":[{"gross_charge":55.01,"discounted_cash":27.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 5 % IN WATER (D5W) IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7070","type":"HCPCS"},{"code":"00990-7922-09","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 20 % 20 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7715-02","type":"NDC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PALMITATE HCL 75 MG/5 ML ORAL SOLR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-26","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.1 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-3352-16","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESTRADIOL 0.1 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00378-3352-99","type":"NDC"}],"standard_charges":[{"gross_charge":56.16,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.2 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00591-3509-04","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.2 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00591-3509-54","type":"NDC"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACTIC ACID (BULK) 88 % TO 92 % (USP) MISC LIQD","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"03877-9056-55","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN SPONGE,ABSORB-PORCINE 12-7 MM TOP SPGE","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"09999-9996-07","type":"NDC"}],"standard_charges":[{"gross_charge":57.7,"discounted_cash":28.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODINE-POTASSIUM IODIDE 5-10 % TOP SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"38779-0598-05","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC SUBSULFATE 0.2 TO 0.22 GRAM/ML TOP SOLA","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"48783-0112-08","type":"NDC"}],"standard_charges":[{"gross_charge":56.84,"discounted_cash":28.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC SUBSULFATE 259 MG/G TOP SOLN","drug_information":{"unit":"8","type":"GR"},"code_information":[{"code":"59365-6065-00","type":"NDC"}],"standard_charges":[{"gross_charge":58.34,"discounted_cash":29.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC SUBSULFATE 259 MG/G TOP SOLN","drug_information":{"unit":"8","type":"GR"},"code_information":[{"code":"59365-6065-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.34,"discounted_cash":29.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PALMITATE HCL 75 MG/5 ML ORAL SOLR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"65862-0596-02","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLU VACC TS2024-25 6MOS UP(PF) 45 MCG (15 MCG X 3)/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90656","type":"HCPCS"},{"code":"19515-0810-41","type":"NDC"}],"standard_charges":[{"gross_charge":57.1,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLU VACC TS2024-25 6MOS UP(PF) 45 MCG (15 MCG X 3)/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90656","type":"HCPCS"},{"code":"19515-0810-52","type":"NDC"}],"standard_charges":[{"gross_charge":57.1,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-03","type":"NDC"}],"standard_charges":[{"gross_charge":57.03,"discounted_cash":28.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 7.5 MMOL/7.5 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-07","type":"NDC"}],"standard_charges":[{"gross_charge":57.03,"discounted_cash":28.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCCINATE  100 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0825-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.2,"discounted_cash":29.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00409-1782-03","type":"NDC"}],"standard_charges":[{"gross_charge":57.53,"discounted_cash":28.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 0.4 MG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2310","type":"HCPCS"},{"code":"00409-1782-69","type":"NDC"}],"standard_charges":[{"gross_charge":57.53,"discounted_cash":28.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"00641-6182-01","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":29.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2360","type":"HCPCS"},{"code":"00641-6182-25","type":"NDC"}],"standard_charges":[{"gross_charge":58.05,"discounted_cash":29.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"2500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9991-29","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 5 MG/ML IVPB - FROM STOCK SOLUTION","drug_information":{"unit":"2500","type":"ME"},"code_information":[{"code":"J3370","type":"HCPCS"},{"code":"09999-9991-29","type":"NDC"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 2 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J3485","type":"HCPCS"},{"code":"09999-9999-30","type":"NDC"}],"standard_charges":[{"gross_charge":57.6,"discounted_cash":28.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) IV SYRG","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00409-7517-16","type":"NDC"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 50 % IN WATER (D50W) IV SYRG","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00409-7517-66","type":"NDC"}],"standard_charges":[{"gross_charge":56.8,"discounted_cash":28.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"71288-0114-50","type":"NDC"}],"standard_charges":[{"gross_charge":57.28,"discounted_cash":28.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 15 MG/ML OPHT DROP (COMPOUNDED)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0000-26","type":"NDC"}],"standard_charges":[{"gross_charge":59.76,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  12 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00406-9112-76","type":"NDC"}],"standard_charges":[{"gross_charge":60.54,"discounted_cash":30.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTROSE 25 % IN WATER (D25W) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-1775-10","type":"NDC"}],"standard_charges":[{"gross_charge":59.52,"discounted_cash":29.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUND VEHICLE SUSP SF NO.20 ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-0303-16","type":"NDC"}],"standard_charges":[{"gross_charge":60.55,"discounted_cash":30.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUNDING VEHICLE SYRUP NO23 ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-0304-16","type":"NDC"}],"standard_charges":[{"gross_charge":60.55,"discounted_cash":30.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUNDING VEHICLE SUSP NO.19 ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-0311-16","type":"NDC"}],"standard_charges":[{"gross_charge":60.55,"discounted_cash":30.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  2 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"24208-0276-15","type":"NDC"}],"standard_charges":[{"gross_charge":59.22,"discounted_cash":29.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT- 200 MCG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"54643-5646-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.54,"discounted_cash":29.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABEPRAZOLE 20 MG ORAL TBEC","drug_information":{"unit":"90","type":"UN"},"code_information":[{"code":"62856-0243-90","type":"NDC"}],"standard_charges":[{"gross_charge":59.87,"discounted_cash":29.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORTIOXETINE  5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64764-0720-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.84,"discounted_cash":30.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORTIOXETINE 10 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64764-0730-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.84,"discounted_cash":30.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VORTIOXETINE 20 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"64764-0750-30","type":"NDC"}],"standard_charges":[{"gross_charge":60.84,"discounted_cash":30.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 5 % TOP OINT","drug_information":{"unit":"15","type":"GR"},"code_information":[{"code":"72578-0082-01","type":"NDC"}],"standard_charges":[{"gross_charge":59.4,"discounted_cash":29.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4 % (1 MEQ/ML) IV SYRG","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"76329-3352-01","type":"NDC"}],"standard_charges":[{"gross_charge":60.2,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TO 99M ALBUMIN AGGREGATED","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9540","type":"HCPCS"},{"code":"65174-0270-20","type":"NDC"}],"standard_charges":[{"gross_charge":58.63,"discounted_cash":29.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN-SULBACTAM 30 MG AMPICILLIN/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"201","type":"ML"},"code_information":[{"code":"J0295","type":"HCPCS"},{"code":"09999-9991-82","type":"NDC"}],"standard_charges":[{"gross_charge":61.11,"discounted_cash":30.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUMAN 100 UNITS ML (CPU) FOR GLUCOMMANDER","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9998-74","type":"NDC"}],"standard_charges":[{"gross_charge":60.28,"discounted_cash":30.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"51991-0144-17","type":"NDC"}],"standard_charges":[{"gross_charge":61.31,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2210","type":"HCPCS"},{"code":"51991-0144-99","type":"NDC"}],"standard_charges":[{"gross_charge":61.31,"discounted_cash":30.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE (BULK) 100 % MISC POWD","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"J2550","type":"HCPCS"},{"code":"51552-0147-02","type":"NDC"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE *SQ* CHEMO SYRINGE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"71288-0109-20","type":"NDC"}],"standard_charges":[{"gross_charge":59.68,"discounted_cash":29.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE *SQ* CHEMO SYRINGE - PEDIATRIC","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"71288-0109-20","type":"NDC"}],"standard_charges":[{"gross_charge":59.68,"discounted_cash":29.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 240 MG IODINE/ML IV SOLN 150 ML BTL","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00407-1412-34","type":"NDC"}],"standard_charges":[{"gross_charge":58.8,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL 20 MG/5 ML ORAL ELIX (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-17","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":31.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG/10 ML ORAL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0102-63","type":"NDC"}],"standard_charges":[{"gross_charge":61.64,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NOREPINEPHRINE 8 MG/250 ML IN D5W (32 MCG/ML) INFUSION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00000-0103-30","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE  10 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0237-63","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACTIVATED CHARCOAL 50 GRAM/240 ML ORAL SUSP","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00574-0521-76","type":"NDC"}],"standard_charges":[{"gross_charge":62.4,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00574-4031-05","type":"NDC"}],"standard_charges":[{"gross_charge":61.44,"discounted_cash":30.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMOLLIENT COMBINATION NO.10 TOP EMUL","drug_information":{"unit":"45","type":"GR"},"code_information":[{"code":"05898-0960-12","type":"NDC"}],"standard_charges":[{"gross_charge":61.56,"discounted_cash":30.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML RETENTION ENEMA","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9952-85","type":"NDC"}],"standard_charges":[{"gross_charge":63.36,"discounted_cash":31.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT DRPS ED PACK","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"09999-9996-06","type":"NDC"}],"standard_charges":[{"gross_charge":61.44,"discounted_cash":30.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TPN NICU STARTER 150 ML BAG STEP 2","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"09999-9999-12","type":"NDC"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL 20 MG/5 ML (4 MG/ML) ORAL ELIX","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"16571-0675-16","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":31.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE  60 % ORAL CREA 454 G TUBE","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"32909-0770-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.56,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"66794-0255-02","type":"NDC"}],"standard_charges":[{"gross_charge":62.48,"discounted_cash":31.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"66794-0255-42","type":"NDC"}],"standard_charges":[{"gross_charge":62.48,"discounted_cash":31.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAMETHASONE ACET & SOD PHOS 12 MG/2 ML INJ RPK","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0702","type":"HCPCS"},{"code":"00000-0088-23","type":"NDC"}],"standard_charges":[{"gross_charge":61.92,"discounted_cash":30.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0713","type":"HCPCS"},{"code":"09999-9998-06","type":"NDC"}],"standard_charges":[{"gross_charge":61.6,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM IN 0.9 % SOD CHLORID 1 MG/ML IV SOLN S.O.","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2250","type":"HCPCS"},{"code":"73702-0401-02","type":"NDC"}],"standard_charges":[{"gross_charge":63.2,"discounted_cash":31.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"63323-0475-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.24,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 10 MG/ML (1 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"63323-0475-37","type":"NDC"}],"standard_charges":[{"gross_charge":63.24,"discounted_cash":31.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAPAVERINE 30 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"54288-0142-01","type":"NDC"}],"standard_charges":[{"gross_charge":63.36,"discounted_cash":31.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAPAVERINE 30 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2440","type":"HCPCS"},{"code":"54288-0142-10","type":"NDC"}],"standard_charges":[{"gross_charge":63.36,"discounted_cash":31.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOSTIGMINE METHYLSULFATE 3 MG/3 ML (1 MG/ML) IV SYRG","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J2710","type":"HCPCS"},{"code":"69374-0932-03","type":"NDC"}],"standard_charges":[{"gross_charge":62.01,"discounted_cash":31.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"70092-1068-07","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"70092-1552-07","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"71266-5000-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"71266-5100-01","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"71506-0028-59","type":"NDC"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 125 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"00000-0048-45","type":"NDC"}],"standard_charges":[{"gross_charge":67.31,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE (WITH SUGAR) 100 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00000-0080-07","type":"NDC"}],"standard_charges":[{"gross_charge":67.03,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOSPHATE  50 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00006-0112-31","type":"NDC"}],"standard_charges":[{"gross_charge":64.07,"discounted_cash":32.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOSPHATE  25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00006-0221-31","type":"NDC"}],"standard_charges":[{"gross_charge":64.07,"discounted_cash":32.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SITAGLIPTIN PHOSPHATE 100 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00006-0277-31","type":"NDC"}],"standard_charges":[{"gross_charge":64.07,"discounted_cash":32.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-5534-14","type":"NDC"}],"standard_charges":[{"gross_charge":67.08,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 4.2 % (0.5 MEQ/ML) IV SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-5534-24","type":"NDC"}],"standard_charges":[{"gross_charge":67.08,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUAIFENESIN 100 MG/5 ML ORAL LIQD","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00904-6763-20","type":"NDC"}],"standard_charges":[{"gross_charge":66.08,"discounted_cash":33.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLCELLULOSE (BULK) 1 % MISC GEL","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"05155-2070-27","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTOMEGALOVIRUS IMMUNE GLOBULIN INFUSION","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-29","type":"NDC"}],"standard_charges":[{"gross_charge":67.9,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4% SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9900-84","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSR 200 ML ED PACK","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"09999-9997-68","type":"NDC"}],"standard_charges":[{"gross_charge":64.8,"discounted_cash":32.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 125 MG/5 ML ORAL SUSP","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"51672-4069-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.31,"discounted_cash":33.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE (WITH SUGAR) 100 MG/ML ORAL SOLN","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"52817-0830-04","type":"NDC"}],"standard_charges":[{"gross_charge":67.03,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML (0.1 MMOL/0.2 ML) IV SOLN 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9577","type":"HCPCS"},{"code":"00270-5164-13","type":"NDC"}],"standard_charges":[{"gross_charge":63.64,"discounted_cash":31.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBQ SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55111-0679-10","type":"NDC"}],"standard_charges":[{"gross_charge":65.98,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FONDAPARINUX 5 MG/0.4 ML SUBQ SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J1652","type":"HCPCS"},{"code":"55111-0679-11","type":"NDC"}],"standard_charges":[{"gross_charge":65.98,"discounted_cash":32.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"63323-0476-01","type":"NDC"}],"standard_charges":[{"gross_charge":64.8,"discounted_cash":32.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"63323-0476-37","type":"NDC"}],"standard_charges":[{"gross_charge":64.8,"discounted_cash":32.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON 0.25 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"60505-6193-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.08,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON 0.25 MG/5 ML S.O.","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"60505-6193-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.08,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALONOSETRON 0.25 MG/5 ML S.O. PEDIATRIC","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2469","type":"HCPCS"},{"code":"60505-6193-01","type":"NDC"}],"standard_charges":[{"gross_charge":67.08,"discounted_cash":33.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 2,500 MCG/250 ML (10 MCG/ML) PREMADE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"00000-4270-00","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 2,500 MCG/250 ML (10 MCG/ML) PREMADE","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3010","type":"HCPCS"},{"code":"63037-0101-05","type":"NDC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL (HCL) 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7519","type":"HCPCS"},{"code":"71288-0803-20","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL (HCL) 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7519","type":"HCPCS"},{"code":"71288-0803-21","type":"NDC"}],"standard_charges":[{"gross_charge":65.52,"discounted_cash":32.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 200 MG/5 ML ORAL SUSR","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"00093-2026-31","type":"NDC"}],"standard_charges":[{"gross_charge":64.56,"discounted_cash":32.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 50 MG/5 ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0056-59","type":"NDC"}],"standard_charges":[{"gross_charge":68.04,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE 3 MILLIMOLE/ML ORAL *PF*(ANY SIZE)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0085-41","type":"NDC"}],"standard_charges":[{"gross_charge":68.1,"discounted_cash":34.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 2.5% GEL","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"00295-7520-40","type":"NDC"}],"standard_charges":[{"gross_charge":69.4,"discounted_cash":34.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  75 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00378-9123-16","type":"NDC"}],"standard_charges":[{"gross_charge":69.91,"discounted_cash":34.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL  75 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00378-9123-98","type":"NDC"}],"standard_charges":[{"gross_charge":69.91,"discounted_cash":34.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEPPERMINT OIL MISC OIL","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00395-2015-91","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"03877-9052-78","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM SACCHARIN (BULK) 100 % ORAL POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"05155-2018-74","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILICA GEL,AMORP SYN MC (BULK) 100 % MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"06299-1136-71","type":"NDC"}],"standard_charges":[{"gross_charge":68.4,"discounted_cash":34.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE 8.4% SOLUTION (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"09999-9900-76","type":"NDC"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 0.75 % (37.5MG/5 GRAM) VAGL GEL","drug_information":{"unit":"70","type":"GR"},"code_information":[{"code":"21922-0039-23","type":"NDC"}],"standard_charges":[{"gross_charge":69.72,"discounted_cash":34.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARAVIROC 300 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"31722-0580-60","type":"NDC"}],"standard_charges":[{"gross_charge":70.6,"discounted_cash":35.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG/ML ORAL DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"54838-0506-15","type":"NDC"}],"standard_charges":[{"gross_charge":70.86,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"65219-0535-50","type":"NDC"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZINC OXIDE 20 % TOP OINT","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"68001-0533-50","type":"NDC"}],"standard_charges":[{"gross_charge":69.01,"discounted_cash":34.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 5 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"70710-1014-01","type":"NDC"}],"standard_charges":[{"gross_charge":68.07,"discounted_cash":34.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COSYNTROPIN 1 MCG/ML FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0834","type":"HCPCS"},{"code":"09999-9992-02","type":"NDC"}],"standard_charges":[{"gross_charge":70.32,"discounted_cash":35.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1 %-1:200,000 INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0487-37","type":"NDC"}],"standard_charges":[{"gross_charge":69.36,"discounted_cash":34.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"00143-9209-01","type":"NDC"}],"standard_charges":[{"gross_charge":69.84,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE (PF) 20 MG/ML (2 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"00143-9209-10","type":"NDC"}],"standard_charges":[{"gross_charge":69.84,"discounted_cash":34.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"43066-0152-01","type":"NDC"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"63323-0285-51","type":"NDC"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPIVACAINE (PF) 2 MG/ML (0.2 %) INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2795","type":"HCPCS"},{"code":"63323-0285-65","type":"NDC"}],"standard_charges":[{"gross_charge":70.8,"discounted_cash":35.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTARABINE (PF) 20 MG/ML INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9100","type":"HCPCS"},{"code":"61703-0303-46","type":"NDC"}],"standard_charges":[{"gross_charge":69.4,"discounted_cash":34.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 10 MG/5 ML SUSPENSION 480 ML","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"00000-0031-38","type":"NDC"}],"standard_charges":[{"gross_charge":71.04,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 10 MG/5 ML SUSPENSION 480 ML (ANY SIZE)","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"00000-0031-38","type":"NDC"}],"standard_charges":[{"gross_charge":71.04,"discounted_cash":35.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYOSCYAMINE SULFATE 0.125 MG/ML ORAL DROP (ANY SIZE)","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00000-0057-44","type":"NDC"}],"standard_charges":[{"gross_charge":70.86,"discounted_cash":35.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN 99.5 % TOP SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00395-1031-16","type":"NDC"}],"standard_charges":[{"gross_charge":73.79,"discounted_cash":36.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHROMIUM CHLORIDE 4 MCG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4093-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.52,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHROMIUM CHLORIDE 4 MCG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4093-11","type":"NDC"}],"standard_charges":[{"gross_charge":71.52,"discounted_cash":35.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE  0.9 % IR SOLN","drug_information":{"unit":"3000","type":"ML"},"code_information":[{"code":"00409-7972-08","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRACE ELEMENTS ZN-CU-MN-SE 1,000MCG-60MCG- 3 MCG-6 MCG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00517-9302-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.19,"discounted_cash":36.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRACE ELEMENTS ZN-CU-MN-SE 1,000MCG-60MCG- 3 MCG-6 MCG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00517-9302-25","type":"NDC"}],"standard_charges":[{"gross_charge":72.19,"discounted_cash":36.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUMATRIPTAN  5 MG/ACTUATION NASL SPRY","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00527-1818-43","type":"NDC"}],"standard_charges":[{"gross_charge":73.57,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILICON DIOXIDE (BULK) MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"03877-9193-35","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLYETHYLENE GLYCOL 300 (BULK) MISC LIQD","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"06299-1133-41","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM BICARBONATE (BULK) MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"06299-1170-11","type":"NDC"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM CHLORIDE 50% IN ISOPROPANOL 50% TOP SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9997-37","type":"NDC"}],"standard_charges":[{"gross_charge":73.56,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALUMINUM CHLORIDE 70% IN WATER 30% TOP SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9997-39","type":"NDC"}],"standard_charges":[{"gross_charge":73.56,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 1 MG/ML IV SYRINGE - NICU STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1230","type":"HCPCS"},{"code":"09999-9999-44","type":"NDC"}],"standard_charges":[{"gross_charge":72.84,"discounted_cash":36.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8799-01","type":"NDC"}],"standard_charges":[{"gross_charge":72.57,"discounted_cash":36.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8799-59","type":"NDC"}],"standard_charges":[{"gross_charge":72.57,"discounted_cash":36.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200,000 INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0489-27","type":"NDC"}],"standard_charges":[{"gross_charge":71.84,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML IV PCA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9910-17","type":"NDC"}],"standard_charges":[{"gross_charge":73.56,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML IV PCA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"09999-9997-56","type":"NDC"}],"standard_charges":[{"gross_charge":73.56,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 30 MG/30 ML IV PCA","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"76329-1912-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.56,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"00143-9210-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.36,"discounted_cash":36.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROPROCAINE (PF) 30 MG/ML (3 %) INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2401","type":"HCPCS"},{"code":"00143-9210-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.36,"discounted_cash":36.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"44206-0300-01","type":"NDC"}],"standard_charges":[{"gross_charge":71.85,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG)/2 ML INJ SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2791","type":"HCPCS"},{"code":"44206-0300-90","type":"NDC"}],"standard_charges":[{"gross_charge":71.85,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  2000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.68,"discounted_cash":36.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  2000 UNITS/ML INJ SOLN PARTIAL DOSE / NICU","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1305-01","type":"NDC"}],"standard_charges":[{"gross_charge":73.68,"discounted_cash":36.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  2000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1305-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.68,"discounted_cash":36.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  2000 UNITS/ML INJ SOLN PARTIAL DOSE / NICU","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1305-10","type":"NDC"}],"standard_charges":[{"gross_charge":73.68,"discounted_cash":36.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUTORPHANOL 10 MG/ML NASL SPRY","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"00054-3090-36","type":"NDC"}],"standard_charges":[{"gross_charge":76.16,"discounted_cash":38.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % TOP CREA","drug_information":{"unit":"45","type":"GR"},"code_information":[{"code":"00168-0258-46","type":"NDC"}],"standard_charges":[{"gross_charge":75.24,"discounted_cash":37.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPROMELLOSE MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"03877-9322-35","type":"NDC"}],"standard_charges":[{"gross_charge":78.8,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SORBITOL 70 % MISC SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"04628-7500-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.68,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID (BULK)   5 % MISC LIQD","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"05155-2005-56","type":"NDC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSR","drug_information":{"unit":"35","type":"ML"},"code_information":[{"code":"57237-0150-35","type":"NDC"}],"standard_charges":[{"gross_charge":77.56,"discounted_cash":38.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNIT/GRAM TOP POWD","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"68382-0370-03","type":"NDC"}],"standard_charges":[{"gross_charge":77.52,"discounted_cash":38.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMPANEL  2 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"69616-0272-30","type":"NDC"}],"standard_charges":[{"gross_charge":77.15,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM-KETAMINE-ONDANSETRON 3-25-2 MG SL TROC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"71384-0630-21","type":"NDC"}],"standard_charges":[{"gross_charge":73.92,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE (PF) 3.5 % OPHT GEL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"82584-0792-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.28,"discounted_cash":37.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90700","type":"HCPCS"},{"code":"58160-0810-01","type":"NDC"}],"standard_charges":[{"gross_charge":76.46,"discounted_cash":38.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90700","type":"HCPCS"},{"code":"58160-0810-11","type":"NDC"}],"standard_charges":[{"gross_charge":76.46,"discounted_cash":38.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN 15 ML VIAL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"00270-1111-02","type":"NDC"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":39.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-08","type":"NDC"}],"standard_charges":[{"gross_charge":76.04,"discounted_cash":38.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBUTROL 10 MMOL/10 ML (1 MMOL/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9585","type":"HCPCS"},{"code":"65219-0281-10","type":"NDC"}],"standard_charges":[{"gross_charge":76.04,"discounted_cash":38.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPICILLIN SODIUM  2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0290","type":"HCPCS"},{"code":"00781-3413-92","type":"NDC"}],"standard_charges":[{"gross_charge":78.77,"discounted_cash":39.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COSYNTROPIN 0.25 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0834","type":"HCPCS"},{"code":"00548-5900-00","type":"NDC"}],"standard_charges":[{"gross_charge":74.54,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOPROSTENOL 0.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"62756-0059-40","type":"NDC"}],"standard_charges":[{"gross_charge":74.08,"discounted_cash":37.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN  4 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"43598-0931-09","type":"NDC"}],"standard_charges":[{"gross_charge":74.54,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN  4 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"43598-0931-11","type":"NDC"}],"standard_charges":[{"gross_charge":74.54,"discounted_cash":37.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3410","type":"HCPCS"},{"code":"00517-5601-25","type":"NDC"}],"standard_charges":[{"gross_charge":76.37,"discounted_cash":38.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"69097-0708-31","type":"NDC"}],"standard_charges":[{"gross_charge":74.56,"discounted_cash":37.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 10 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"69097-0708-96","type":"NDC"}],"standard_charges":[{"gross_charge":74.56,"discounted_cash":37.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA (SINGLE DOSE)","drug_information":{"unit":"8.5","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"68180-0963-01","type":"NDC"}],"standard_charges":[{"gross_charge":75.62,"discounted_cash":37.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 51 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00270-1317-05","type":"NDC"}],"standard_charges":[{"gross_charge":74.2,"discounted_cash":37.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-71","type":"NDC"}],"standard_charges":[{"gross_charge":79.47,"discounted_cash":39.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMANTADINE HCL 50 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0646-16","type":"NDC"}],"standard_charges":[{"gross_charge":79.47,"discounted_cash":39.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00409-1130-02","type":"NDC"}],"standard_charges":[{"gross_charge":79.0,"discounted_cash":39.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUND VEH.SUSP SUGAR-FREE 3 ORAL SUSP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"05155-2107-95","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"24208-0910-55","type":"NDC"}],"standard_charges":[{"gross_charge":79.31,"discounted_cash":39.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEG 3350-ELECTROLYTES 236-22.74-6.74 -5.86 GRAM ORAL SOLR","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"52268-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEG 3350-ELECTROLYTES 236-22.74-6.74 -5.86 GRAM ORAL SOLR - (ANY SIZE)","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"52268-0100-PH","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMUL-SOY-MCT-OLIV-FISH OIL 20 % IV EMUL","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"63323-0820-00","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PERTECHNETATE TC 99M INJECTION","drug_information":{"unit":"0.875","type":"UN"},"code_information":[{"code":"A9512","type":"HCPCS"},{"code":"00019-9883-11","type":"NDC"}],"standard_charges":[{"gross_charge":81.48,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M LABELED RED BLOOD CELLS","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9560","type":"HCPCS"},{"code":"00019-NO68-00","type":"NDC"}],"standard_charges":[{"gross_charge":81.44,"discounted_cash":40.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 350 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"71288-0163-30","type":"NDC"}],"standard_charges":[{"gross_charge":79.34,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG/ML INJ SOLN (1ML)","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1230","type":"HCPCS"},{"code":"00000-0116-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":39.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"55150-0282-09","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"72266-0159-01","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"72266-0159-05","type":"NDC"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSAPREPITANT 1 MG/ML - PEDIATRIC","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"09999-9998-85","type":"NDC"}],"standard_charges":[{"gross_charge":81.6,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSAPREPITANT 1 MG/ML 30 MIN - PEDIATRIC","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"09999-9998-85","type":"NDC"}],"standard_charges":[{"gross_charge":81.6,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0011-03","type":"NDC"}],"standard_charges":[{"gross_charge":79.38,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 100 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":79.38,"discounted_cash":39.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE 200 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1955","type":"HCPCS"},{"code":"00143-9852-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.36,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE 200 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1955","type":"HCPCS"},{"code":"00143-9852-10","type":"NDC"}],"standard_charges":[{"gross_charge":80.36,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOCARNITINE 200 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1955","type":"HCPCS"},{"code":"54482-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":80.36,"discounted_cash":40.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375G IVPB PREMIX PEDS ONLY","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9636-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM-DEXTRS 3.375 GRAM/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9636-01","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 3.375G IVPB PREMIX PEDS ONLY","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9636-24","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM-DEXTRS 3.375 GRAM/50 ML IV PGBK","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9636-24","type":"NDC"}],"standard_charges":[{"gross_charge":81.2,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLP","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"J7030","type":"HCPCS"},{"code":"00990-7983-09","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ULTRASOUND GEL","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"KDL30-5920-86","type":"NDC"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZITHROMYCIN 1 G ORAL PACK","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"Q0144","type":"HCPCS"},{"code":"59762-3051-02","type":"NDC"}],"standard_charges":[{"gross_charge":80.42,"discounted_cash":40.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN 150 ML BTL","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-65","type":"NDC"}],"standard_charges":[{"gross_charge":81.6,"discounted_cash":40.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEPHALEXIN 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"00093-4177-74","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRACE ELEMENTS ZN-CU-MN-SE 3 MG-0.3 MG-55 MCG-60 MCG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00517-9305-01","type":"NDC"}],"standard_charges":[{"gross_charge":86.47,"discounted_cash":43.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRACE ELEMENTS ZN-CU-MN-SE 3 MG-0.3 MG-55 MCG-60 MCG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"00517-9305-25","type":"NDC"}],"standard_charges":[{"gross_charge":86.47,"discounted_cash":43.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUPPOSITORY BASE NO.216 (BULK) MISC WAX","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"00574-0308-16","type":"NDC"}],"standard_charges":[{"gross_charge":85.36,"discounted_cash":42.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.3 MG/24 HR TD PTWK","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"00591-3510-04","type":"NDC"}],"standard_charges":[{"gross_charge":83.66,"discounted_cash":41.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE 0.3 MG/24 HR TD PTWK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00591-3510-54","type":"NDC"}],"standard_charges":[{"gross_charge":83.66,"discounted_cash":41.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"04081-0548-21","type":"NDC"}],"standard_charges":[{"gross_charge":87.2,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALMOND OIL, SWEET (BULK) MISC OIL","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"06299-1295-91","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN (BULK) 100 % MISC POWD","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"51552-0613-02","type":"NDC"}],"standard_charges":[{"gross_charge":86.28,"discounted_cash":43.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUCCIMER 100 MG ORAL CAP","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"55292-0201-11","type":"NDC"}],"standard_charges":[{"gross_charge":88.14,"discounted_cash":44.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE 1 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"61314-0396-03","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML ORAL SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"69315-0318-20","type":"NDC"}],"standard_charges":[{"gross_charge":87.2,"discounted_cash":43.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"70752-0102-12","type":"NDC"}],"standard_charges":[{"gross_charge":83.25,"discounted_cash":41.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90700","type":"HCPCS"},{"code":"58160-0810-43","type":"NDC"}],"standard_charges":[{"gross_charge":83.56,"discounted_cash":41.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET PED (PF) 25-58-10 LF-MCG-LF/0.5ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90700","type":"HCPCS"},{"code":"58160-0810-52","type":"NDC"}],"standard_charges":[{"gross_charge":83.56,"discounted_cash":41.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOPAMINE IN 5 % DEXTROSE 800 MG/500 ML (1,600 MCG/ML) IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J1265","type":"HCPCS"},{"code":"00338-1007-03","type":"NDC"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200,000 INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2004","type":"HCPCS"},{"code":"63323-0488-37","type":"NDC"}],"standard_charges":[{"gross_charge":82.56,"discounted_cash":41.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN IN 5 % DEXTROSE 50 MG/250 ML (200 MCG/ML) IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J2305","type":"HCPCS"},{"code":"00338-1049-02","type":"NDC"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DILTIAZEM 100 MG/100 ML IN NS (1 MG/ML) INFUSION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00000-0046-88","type":"NDC"}],"standard_charges":[{"gross_charge":84.8,"discounted_cash":42.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL INHALER ED PACK","drug_information":{"unit":"8","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00000-0101-94","type":"NDC"}],"standard_charges":[{"gross_charge":83.84,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL MDI 90 MCG/ACTUATION - PT OWN SUPPLY FOR ED","drug_information":{"unit":"8","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00173-0682-24","type":"NDC"}],"standard_charges":[{"gross_charge":83.84,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 90 MCG/ACTUATION INHL HFAA","drug_information":{"unit":"8","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00173-0682-24","type":"NDC"}],"standard_charges":[{"gross_charge":83.84,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 50 MG/25 ML IV SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00069-3032-20","type":"NDC"}],"standard_charges":[{"gross_charge":84.7,"discounted_cash":42.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00270-1316-30","type":"NDC"}],"standard_charges":[{"gross_charge":85.4,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN 150 ML *MULTI-DOSE* BTL","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-93","type":"NDC"}],"standard_charges":[{"gross_charge":85.8,"discounted_cash":42.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL ELIX (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0040-24","type":"NDC"}],"standard_charges":[{"gross_charge":90.82,"discounted_cash":45.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYPROHEPTADINE 2 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0054-61","type":"NDC"}],"standard_charges":[{"gross_charge":90.82,"discounted_cash":45.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 4 MG DOSE PACK #21 ED PACK","drug_information":{"unit":"21","type":"UN"},"code_information":[{"code":"00000-0086-06","type":"NDC"}],"standard_charges":[{"gross_charge":89.63,"discounted_cash":44.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THEOPHYLLINE 80 MG/15 ML ORAL ELIX","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0820-16","type":"NDC"}],"standard_charges":[{"gross_charge":90.82,"discounted_cash":45.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TERCONAZOLE 0.4 % VAGL CREA","drug_information":{"unit":"45","type":"GR"},"code_information":[{"code":"00168-0346-46","type":"NDC"}],"standard_charges":[{"gross_charge":88.56,"discounted_cash":44.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM  25 MG ORAL TAB","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"50474-0470-09","type":"NDC"}],"standard_charges":[{"gross_charge":89.26,"discounted_cash":44.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM  50 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"50474-0570-66","type":"NDC"}],"standard_charges":[{"gross_charge":89.26,"discounted_cash":44.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOBAZAM 2.5 MG/ML ORAL SUSP","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"59651-0401-12","type":"NDC"}],"standard_charges":[{"gross_charge":88.32,"discounted_cash":44.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE ACETATE 1 % OPHT DRPS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0637-05","type":"NDC"}],"standard_charges":[{"gross_charge":88.24,"discounted_cash":44.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYPROHEPTADINE 2 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"64980-0504-48","type":"NDC"}],"standard_charges":[{"gross_charge":90.82,"discounted_cash":45.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0747-25","type":"NDC"}],"standard_charges":[{"gross_charge":88.56,"discounted_cash":44.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"63323-0401-01","type":"NDC"}],"standard_charges":[{"gross_charge":89.41,"discounted_cash":44.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"63323-0401-20","type":"NDC"}],"standard_charges":[{"gross_charge":89.41,"discounted_cash":44.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 1 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"68382-0860-02","type":"NDC"}],"standard_charges":[{"gross_charge":89.45,"discounted_cash":44.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENZTROPINE 1 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0515","type":"HCPCS"},{"code":"68382-0860-10","type":"NDC"}],"standard_charges":[{"gross_charge":89.45,"discounted_cash":44.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1120","type":"HCPCS"},{"code":"00143-9503-01","type":"NDC"}],"standard_charges":[{"gross_charge":91.32,"discounted_cash":45.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"25021-0191-10","type":"NDC"}],"standard_charges":[{"gross_charge":88.98,"discounted_cash":44.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"25021-0191-11","type":"NDC"}],"standard_charges":[{"gross_charge":88.98,"discounted_cash":44.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"76329-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.96,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHYTONADIONE (VITAMIN K1) 1 MG/0.5 ML INJ SYRG (NO DOSE CHECK)","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J3430","type":"HCPCS"},{"code":"76329-1240-01","type":"NDC"}],"standard_charges":[{"gross_charge":88.96,"discounted_cash":44.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KETAMINE  10 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"25021-0682-20","type":"NDC"}],"standard_charges":[{"gross_charge":90.4,"discounted_cash":45.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 50 MG RECT SUPP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0132-06","type":"NDC"}],"standard_charges":[{"gross_charge":89.96,"discounted_cash":44.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROMETHAZINE 50 MG RECT SUPP","drug_information":{"unit":"12","type":"UN"},"code_information":[{"code":"J8498","type":"HCPCS"},{"code":"00713-0132-12","type":"NDC"}],"standard_charges":[{"gross_charge":89.96,"discounted_cash":44.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BLEOMYCIN 15 UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9040","type":"HCPCS"},{"code":"61703-0332-18","type":"NDC"}],"standard_charges":[{"gross_charge":91.32,"discounted_cash":45.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPOTECAN 4 MG/4 ML (1 MG/ML) IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9351","type":"HCPCS"},{"code":"00409-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":90.96,"discounted_cash":45.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 180 MG IODINE/ML IT SOLN 20 ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"Q9965","type":"HCPCS"},{"code":"00407-1411-20","type":"NDC"}],"standard_charges":[{"gross_charge":89.52,"discounted_cash":44.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL ALCOHOL (BULK) MISC LIQD (ANY SIZE)","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00000-0000-24","type":"NDC"}],"standard_charges":[{"gross_charge":92.16,"discounted_cash":46.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML SOLUTION (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00000-0035-86","type":"NDC"}],"standard_charges":[{"gross_charge":96.96,"discounted_cash":48.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0041-49","type":"NDC"}],"standard_charges":[{"gross_charge":91.4,"discounted_cash":45.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MULTIVIT #40-PHYTONADIONE 400 MCG/ML ORAL DROP (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0061-80","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":45.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATENOLOL 2 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"00000-0070-72","type":"NDC"}],"standard_charges":[{"gross_charge":95.4,"discounted_cash":47.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00378-9124-16","type":"NDC"}],"standard_charges":[{"gross_charge":96.24,"discounted_cash":48.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL 100 MCG/HR TD PT72","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00378-9124-98","type":"NDC"}],"standard_charges":[{"gross_charge":96.24,"discounted_cash":48.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) MISC SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00409-3308-03","type":"NDC"}],"standard_charges":[{"gross_charge":94.68,"discounted_cash":47.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 20 MG/5 ML (4 MG/ML) ORAL SOLN","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00832-6032-12","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAMOTIDINE 40 MG/5 ML (8 MG/ML) ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00832-6045-50","type":"NDC"}],"standard_charges":[{"gross_charge":91.4,"discounted_cash":45.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPARABEN (BULK) MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"05155-2010-16","type":"NDC"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MULTIVIT 40-PHYTONADIONE 400 MCG/ML ORAL DROP","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"05891-4214-60","type":"NDC"}],"standard_charges":[{"gross_charge":91.92,"discounted_cash":45.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORZOLAMIDE-TIMOLOL 22.3-6.8 MG/ML OPHT DROP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"24208-0486-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.12,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MUPIROCIN CALCIUM 2 % TOP CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"51672-1370-02","type":"NDC"}],"standard_charges":[{"gross_charge":95.76,"discounted_cash":47.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE  80 MG ORAL TR12","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"59011-0480-20","type":"NDC"}],"standard_charges":[{"gross_charge":93.16,"discounted_cash":46.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML (0.1 MMOL/0.2 ML) IV SOLN 15 ML VIAL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"A9577","type":"HCPCS"},{"code":"00270-5164-14","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":46.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSAPREPITANT 150 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1453","type":"HCPCS"},{"code":"72205-0054-01","type":"NDC"}],"standard_charges":[{"gross_charge":93.2,"discounted_cash":46.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN (HEGGER'S SOLUTION)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0010-03","type":"NDC"}],"standard_charges":[{"gross_charge":92.96,"discounted_cash":46.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN (HEGGER'S SOLUTION)","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0010-20","type":"NDC"}],"standard_charges":[{"gross_charge":92.96,"discounted_cash":46.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC AC-MANNITOL-0.9NACL 4 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"25021-0826-82","type":"NDC"}],"standard_charges":[{"gross_charge":93.2,"discounted_cash":46.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"00000-0065-64","type":"NDC"}],"standard_charges":[{"gross_charge":93.2,"discounted_cash":46.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONDANSETRON HCL 4 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q0162","type":"HCPCS"},{"code":"65162-0691-79","type":"NDC"}],"standard_charges":[{"gross_charge":93.2,"discounted_cash":46.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN  10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":48.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0300-10","type":"NDC"}],"standard_charges":[{"gross_charge":96.52,"discounted_cash":48.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1,100-334 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0085-60","type":"NDC"}],"standard_charges":[{"gross_charge":98.39,"discounted_cash":49.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CITRATE-CITRIC ACID 1,100-334 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0676-16","type":"NDC"}],"standard_charges":[{"gross_charge":98.39,"discounted_cash":49.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15 ML ORAL LIQD","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0948-16","type":"NDC"}],"standard_charges":[{"gross_charge":99.62,"discounted_cash":49.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COMPOUND VEHICLE SUSP SF NO.18 ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"03877-9260-08","type":"NDC"}],"standard_charges":[{"gross_charge":97.77,"discounted_cash":48.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 2 G IN NS BLADDER IRRIGATION - *COMPOUNDED*","drug_information":{"unit":"52.6","type":"ML"},"code_information":[{"code":"07777-7777-76","type":"NDC"}],"standard_charges":[{"gross_charge":98.06,"discounted_cash":49.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP405 (4-POTASSIUM, 35-BICARB, 140-SODIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"09999-9904-05","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP456 (4-POTASSIUM, 25-BICARB, 140-SODIUM, 0-CALCIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"09999-9904-56","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP400 (2-POTASSIUM, 35-BICARB, 140-SODIUM, 3-CALCIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"09999-9904-57","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP401 (4-POTASSIUM, 35-BICARB, 140-SODIUM, 3-CALCIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"09999-9904-58","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID (VITAMIN C) 1500 MG IVPB","drug_information":{"unit":"56","type":"ML"},"code_information":[{"code":"09999-9992-86","type":"NDC"}],"standard_charges":[{"gross_charge":98.4,"discounted_cash":49.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP453 (2-POTASSIUM, 25-BICARB, 130-SODIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"09999-9998-14","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPARACAINE 0.5 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"61314-0016-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.69,"discounted_cash":49.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL  2.5 % OPHT DROP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"70756-0629-25","type":"NDC"}],"standard_charges":[{"gross_charge":99.12,"discounted_cash":49.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE 3 MG/ML IV SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"25021-0301-76","type":"NDC"}],"standard_charges":[{"gross_charge":98.98,"discounted_cash":49.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 4.5G IVPB PEDS ONLY","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00206-8862-02","type":"NDC"}],"standard_charges":[{"gross_charge":99.06,"discounted_cash":49.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM-DEXTRS 4.5 G/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9638-01","type":"NDC"}],"standard_charges":[{"gross_charge":99.06,"discounted_cash":49.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM-DEXTRS 4.5 G/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"00338-9638-12","type":"NDC"}],"standard_charges":[{"gross_charge":99.06,"discounted_cash":49.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM NICU STOCK SOLUTION","drug_information":{"unit":"225","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9991-55","type":"NDC"}],"standard_charges":[{"gross_charge":99.16,"discounted_cash":49.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIPERACILLIN-TAZOBACTAM 100 MG/ML IV SYRINGE - FROM PEDS STOCK SOLUTION","drug_information":{"unit":"225","type":"ML"},"code_information":[{"code":"J2543","type":"HCPCS"},{"code":"09999-9991-55","type":"NDC"}],"standard_charges":[{"gross_charge":99.16,"discounted_cash":49.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"42494-0416-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.55,"discounted_cash":49.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"42494-0416-25","type":"NDC"}],"standard_charges":[{"gross_charge":98.55,"discounted_cash":49.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRRT RFP403 (2-POTASSIUM, 35-BICARB, 140-SODIUM 0-CALCIUM)","drug_information":{"unit":"5000","type":"ML"},"code_information":[{"code":"J7999","type":"HCPCS"},{"code":"09999-9904-03","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 2 GRAM/52.6 ML (38 MG/ML) IV SOLN","drug_information":{"unit":"52.6","type":"ML"},"code_information":[{"code":"J9201","type":"HCPCS"},{"code":"00409-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.06,"discounted_cash":49.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IFOSFAMIDE 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"10019-0925-01","type":"NDC"}],"standard_charges":[{"gross_charge":98.13,"discounted_cash":49.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IFOSFAMIDE 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"10019-0925-82","type":"NDC"}],"standard_charges":[{"gross_charge":98.13,"discounted_cash":49.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN 200 ML *MULTI-DOSE* BTL","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1413-66","type":"NDC"}],"standard_charges":[{"gross_charge":99.2,"discounted_cash":49.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESFLURANE 100 % INHL LIQD","drug_information":{"unit":"53","type":"ML"},"code_information":[{"code":"00000-0052-24","type":"NDC"}],"standard_charges":[{"gross_charge":103.35,"discounted_cash":51.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE CONCENTRATE 100 MG/5 ML (20 MG/ML) ORAL SOLN","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00054-0517-50","type":"NDC"}],"standard_charges":[{"gross_charge":104.84,"discounted_cash":52.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINONIDE 0.05 % TOP CREA","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"00093-0262-92","type":"NDC"}],"standard_charges":[{"gross_charge":103.2,"discounted_cash":51.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4092-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.38,"discounted_cash":51.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CUPRIC CHLORIDE 0.4 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4092-11","type":"NDC"}],"standard_charges":[{"gross_charge":102.38,"discounted_cash":51.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN 0.5 % OPHT DROP","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"00781-7135-93","type":"NDC"}],"standard_charges":[{"gross_charge":102.65,"discounted_cash":51.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOL  1.5 % TOP LIQD","drug_information":{"unit":"29.57","type":"ML"},"code_information":[{"code":"00884-2893-01","type":"NDC"}],"standard_charges":[{"gross_charge":101.6,"discounted_cash":50.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMCITABINE 1 G IN NS BLADDER IRRIGATION - *COMPOUNDED*","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"07777-7777-75","type":"NDC"}],"standard_charges":[{"gross_charge":100.58,"discounted_cash":50.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE (TAGITOL V) 40 % (W/V) ORAL SUSP 60 ML MULTI-DOSE","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"32909-0814-53","type":"NDC"}],"standard_charges":[{"gross_charge":101.04,"discounted_cash":50.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"69918-0731-10","type":"NDC"}],"standard_charges":[{"gross_charge":104.88,"discounted_cash":52.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLON-MOXIFLOX-WATR(PF) 9 MG-0.6 MG /0.6 ML IO SUSP","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"71384-0746-06","type":"NDC"}],"standard_charges":[{"gross_charge":105.3,"discounted_cash":52.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL  4 % LATR SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"76329-6300-05","type":"NDC"}],"standard_charges":[{"gross_charge":103.14,"discounted_cash":51.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APRACLONIDINE 1 % OPHT DPET","drug_information":{"unit":"24","type":"UN"},"code_information":[{"code":"82667-0200-01","type":"NDC"}],"standard_charges":[{"gross_charge":100.76,"discounted_cash":50.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOPICLENOL 0.5 MMOL/ML IV SOLN 7.5 ML VIAL","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"A9573","type":"HCPCS"},{"code":"00270-7025-40","type":"NDC"}],"standard_charges":[{"gross_charge":100.41,"discounted_cash":50.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOTERIDOL 279.3 MG/ML IV SOLN 20 ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"A9579","type":"HCPCS"},{"code":"00270-1111-03","type":"NDC"}],"standard_charges":[{"gross_charge":102.42,"discounted_cash":51.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 20 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"09999-9999-80","type":"NDC"}],"standard_charges":[{"gross_charge":102.85,"discounted_cash":51.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLISTIN (COLISTIMETHATE NA) 150 MG INJ RESPIRATORY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"39822-0615-01","type":"NDC"}],"standard_charges":[{"gross_charge":102.11,"discounted_cash":51.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLISTIN (COLISTIMETHATE NA) 150 MG INJ RESPIRATORY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0770","type":"HCPCS"},{"code":"39822-0615-02","type":"NDC"}],"standard_charges":[{"gross_charge":102.11,"discounted_cash":51.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLORPROMAZINE  25 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3230","type":"HCPCS"},{"code":"00641-1398-35","type":"NDC"}],"standard_charges":[{"gross_charge":104.6,"discounted_cash":52.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 10 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3485","type":"HCPCS"},{"code":"49702-0213-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.08,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 10 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3485","type":"HCPCS"},{"code":"49702-0213-26","type":"NDC"}],"standard_charges":[{"gross_charge":106.08,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 40 10% IN DEXTROSE 5% IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7100","type":"HCPCS"},{"code":"00409-7418-03","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 40 10% IN DEXTROSE 5% IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7100","type":"HCPCS"},{"code":"00409-7418-13","type":"NDC"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 1 MG/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"16729-0288-38","type":"NDC"}],"standard_charges":[{"gross_charge":101.01,"discounted_cash":50.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE  5 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0061-23","type":"NDC"}],"standard_charges":[{"gross_charge":109.2,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0081-38","type":"NDC"}],"standard_charges":[{"gross_charge":106.47,"discounted_cash":53.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE  5 MG/5 ML ORAL SOLN (BULK)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00054-3555-63","type":"NDC"}],"standard_charges":[{"gross_charge":109.2,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE-SODIUM BENZOATE 250 MG/ML (125 MG/ML CAFFEINE) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00517-2502-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.06,"discounted_cash":54.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAFFEINE-SODIUM BENZOATE 250 MG/ML (125 MG/ML CAFFEINE) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00517-2502-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.06,"discounted_cash":54.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00781-3040-72","type":"NDC"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 5 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00781-3040-95","type":"NDC"}],"standard_charges":[{"gross_charge":109.4,"discounted_cash":54.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MULTIVIT NO.128-VITAMIN K 500 MCG/ML ORAL LIQD","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"06817-6000-10","type":"NDC"}],"standard_charges":[{"gross_charge":109.52,"discounted_cash":54.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ILOPERIDONE  1 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43068-0101-02","type":"NDC"}],"standard_charges":[{"gross_charge":108.33,"discounted_cash":54.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN 10 MG/ML ORAL CONC","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"54838-0512-40","type":"NDC"}],"standard_charges":[{"gross_charge":107.18,"discounted_cash":53.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOXETINE 90 MG ORAL CPDR","drug_information":{"unit":"4","type":"UN"},"code_information":[{"code":"55111-0284-48","type":"NDC"}],"standard_charges":[{"gross_charge":106.55,"discounted_cash":53.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXEPIN 10 MG/ML ORAL CONC (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"60432-0651-00","type":"NDC"}],"standard_charges":[{"gross_charge":107.18,"discounted_cash":53.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFPROZIL 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"68180-0402-01","type":"NDC"}],"standard_charges":[{"gross_charge":106.47,"discounted_cash":53.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLURBIPROFEN SODIUM 0.03 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"69292-0722-25","type":"NDC"}],"standard_charges":[{"gross_charge":108.42,"discounted_cash":54.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90633","type":"HCPCS"},{"code":"58160-0825-43","type":"NDC"}],"standard_charges":[{"gross_charge":106.45,"discounted_cash":53.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A VIRUS VACCINE (PF) 720 ELISA UNIT/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90633","type":"HCPCS"},{"code":"58160-0825-52","type":"NDC"}],"standard_charges":[{"gross_charge":106.45,"discounted_cash":53.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAPTOMYCIN 500 MG IV SOLR","drug_information":{"unit":"500","type":"ME"},"code_information":[{"code":"J0878","type":"HCPCS"},{"code":"60505-6229-04","type":"NDC"}],"standard_charges":[{"gross_charge":109.05,"discounted_cash":54.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0010-03","type":"NDC"}],"standard_charges":[{"gross_charge":107.57,"discounted_cash":53.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GENTAMICIN 40 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1580","type":"HCPCS"},{"code":"63323-0010-20","type":"NDC"}],"standard_charges":[{"gross_charge":107.57,"discounted_cash":53.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZOLEDRONIC ACID-MANNITOL-WATER 5 MG/100 ML IV PGBK","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3489","type":"HCPCS"},{"code":"71288-0806-51","type":"NDC"}],"standard_charges":[{"gross_charge":109.2,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOLIC ACID  5 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"39822-1100-01","type":"NDC"}],"standard_charges":[{"gross_charge":109.05,"discounted_cash":54.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANNITOL 20 % 20 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7799","type":"HCPCS"},{"code":"00990-7715-03","type":"NDC"}],"standard_charges":[{"gross_charge":109.2,"discounted_cash":54.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIATRIZOATE MEGLUMINE 30 % URTH SOLN 300 ML *MULTI-DOSE* BTL","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"Q9958","type":"HCPCS"},{"code":"00270-0149-57","type":"NDC"}],"standard_charges":[{"gross_charge":108.81,"discounted_cash":54.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 10 MG/ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00000-0069-62","type":"NDC"}],"standard_charges":[{"gross_charge":116.07,"discounted_cash":58.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPENTOLATE-PHENYLEPHRINE 0.2-1 % OPHT DROP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00065-0359-02","type":"NDC"}],"standard_charges":[{"gross_charge":116.03,"discounted_cash":58.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (BULK) 100 % MISC POWD","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"00406-1521-53","type":"NDC"}],"standard_charges":[{"gross_charge":117.08,"discounted_cash":58.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL ALCOHOL (BULK) MISC LIQD","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"06299-1253-71","type":"NDC"}],"standard_charges":[{"gross_charge":111.15,"discounted_cash":55.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (NUVISC) 12 MG/ML IO SYRG (PDH)","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"08861-5802-67","type":"NDC"}],"standard_charges":[{"gross_charge":110.34,"discounted_cash":55.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HC VENTISCAN IV","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9992-63","type":"NDC"}],"standard_charges":[{"gross_charge":110.76,"discounted_cash":55.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEDI MULTIVIT NO.128-VITAMIN K 500 MCG/ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"09999-9998-48","type":"NDC"}],"standard_charges":[{"gross_charge":109.52,"discounted_cash":54.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATROPINE 1 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60505-6226-01","type":"NDC"}],"standard_charges":[{"gross_charge":112.52,"discounted_cash":56.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIDOVUDINE 10 MG/ML ORAL SYRP","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"65862-0048-24","type":"NDC"}],"standard_charges":[{"gross_charge":116.07,"discounted_cash":58.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOFLURANE  99.9 % INHL LIQD","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"66794-0017-25","type":"NDC"}],"standard_charges":[{"gross_charge":114.08,"discounted_cash":57.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL  2 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0191-01","type":"NDC"}],"standard_charges":[{"gross_charge":110.63,"discounted_cash":55.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP TC-99M-MEDRONATE SOD 25 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9503","type":"HCPCS"},{"code":"65174-0660-30","type":"NDC"}],"standard_charges":[{"gross_charge":115.3,"discounted_cash":57.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M OXIDRONATE KIT","drug_information":{"unit":"0.91666","type":"UN"},"code_information":[{"code":"A9561","type":"HCPCS"},{"code":"00019-9091-20","type":"NDC"}],"standard_charges":[{"gross_charge":115.51,"discounted_cash":57.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTRIAXONE 40 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J0696","type":"HCPCS"},{"code":"09999-9991-30","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE 28 MG/ML IV SOLUTION - NICU","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"25021-0305-20","type":"NDC"}],"standard_charges":[{"gross_charge":115.82,"discounted_cash":57.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"25021-0305-20","type":"NDC"}],"standard_charges":[{"gross_charge":114.9,"discounted_cash":57.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE IN D5W 1,000 MG/250 ML (4,000 MCG/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"00338-1077-02","type":"NDC"}],"standard_charges":[{"gross_charge":110.18,"discounted_cash":55.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GANCICLOVIR SODIUM 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1570","type":"HCPCS"},{"code":"70436-0089-55","type":"NDC"}],"standard_charges":[{"gross_charge":114.27,"discounted_cash":57.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 50 MG IRON/2.5 ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"00517-2325-01","type":"NDC"}],"standard_charges":[{"gross_charge":114.58,"discounted_cash":57.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 50 MG IRON/2.5 ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"00517-2325-10","type":"NDC"}],"standard_charges":[{"gross_charge":114.58,"discounted_cash":57.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 40 10 % IN 0.9 % NACL 10 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7100","type":"HCPCS"},{"code":"00409-7419-03","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXTRAN 40 10 % IN 0.9 % NACL 10 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J7100","type":"HCPCS"},{"code":"00409-7419-14","type":"NDC"}],"standard_charges":[{"gross_charge":117.0,"discounted_cash":58.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 25 % 25 % IV SOLP 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"44206-0251-05","type":"NDC"}],"standard_charges":[{"gross_charge":116.61,"discounted_cash":58.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 25 % 25 % IV SOLP 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"44206-0251-90","type":"NDC"}],"standard_charges":[{"gross_charge":116.61,"discounted_cash":58.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIA INK 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00000-0036-48","type":"NDC"}],"standard_charges":[{"gross_charge":121.33,"discounted_cash":60.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION-OLIVE-SOY-LIPID 20 % IV EMUL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00338-9540-02","type":"NDC"}],"standard_charges":[{"gross_charge":121.88,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION-OLIVE-SOY-LIPID 20 % IV EMUL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00338-9540-06","type":"NDC"}],"standard_charges":[{"gross_charge":121.88,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00409-1130-02","type":"NDC"}],"standard_charges":[{"gross_charge":122.85,"discounted_cash":61.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANGANESE CHLORIDE 0.1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4091-01","type":"NDC"}],"standard_charges":[{"gross_charge":118.14,"discounted_cash":59.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MANGANESE CHLORIDE 0.1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00409-4091-11","type":"NDC"}],"standard_charges":[{"gross_charge":118.14,"discounted_cash":59.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML RETENTION ENEMA","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"09999-9958-24","type":"NDC"}],"standard_charges":[{"gross_charge":123.56,"discounted_cash":61.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULFACETAMIDE SODIUM 10 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"24208-0670-04","type":"NDC"}],"standard_charges":[{"gross_charge":121.51,"discounted_cash":60.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUTAMINE ASPARTATE 125 ML SOLUTION","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"66647-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.49,"discounted_cash":58.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYLEPHRINE HCL 10 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"70756-0614-30","type":"NDC"}],"standard_charges":[{"gross_charge":123.05,"discounted_cash":61.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICROPLEGIC SOLUTION NO.1 7.84 %-8.56 % (0.92 MOLAR) PERF SOLN","drug_information":{"unit":"125","type":"ML"},"code_information":[{"code":"71285-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.49,"discounted_cash":58.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) IV SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"55150-0259-30","type":"NDC"}],"standard_charges":[{"gross_charge":118.06,"discounted_cash":59.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETYLCYSTEINE 200 MG/ML (20 %) IV SOLN - UNITS IN MG","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0132","type":"HCPCS"},{"code":"55150-0259-30","type":"NDC"}],"standard_charges":[{"gross_charge":118.06,"discounted_cash":59.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 100 MG/100 ML INFUSION - PRMC","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"09999-9998-01","type":"NDC"}],"standard_charges":[{"gross_charge":121.29,"discounted_cash":60.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 2 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"09999-9999-51","type":"NDC"}],"standard_charges":[{"gross_charge":123.63,"discounted_cash":61.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICAFUNGIN 4 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"12.5","type":"ML"},"code_information":[{"code":"J2248","type":"HCPCS"},{"code":"09999-9999-41","type":"NDC"}],"standard_charges":[{"gross_charge":119.83,"discounted_cash":59.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAFCILLIN  10 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"70860-0119-99","type":"NDC"}],"standard_charges":[{"gross_charge":122.97,"discounted_cash":61.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG INJ SOLR 25 MG/ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"43598-0143-62","type":"NDC"}],"standard_charges":[{"gross_charge":119.93,"discounted_cash":59.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPIRUBICIN 50 MG/25 ML IV SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J9178","type":"HCPCS"},{"code":"00009-5091-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.78,"discounted_cash":58.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPIRUBICIN CHEMO SYRINGE","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J9178","type":"HCPCS"},{"code":"00009-5091-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.78,"discounted_cash":58.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IFOSFAMIDE 1 GRAM/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"00143-9531-01","type":"NDC"}],"standard_charges":[{"gross_charge":117.78,"discounted_cash":58.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINORELBINE 50 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9390","type":"HCPCS"},{"code":"25021-0204-05","type":"NDC"}],"standard_charges":[{"gross_charge":123.56,"discounted_cash":61.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 5 % 5 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"44206-0310-25","type":"NDC"}],"standard_charges":[{"gross_charge":121.88,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 5 % 5 % IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"44206-0310-90","type":"NDC"}],"standard_charges":[{"gross_charge":121.88,"discounted_cash":60.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0037-44","type":"NDC"}],"standard_charges":[{"gross_charge":127.29,"discounted_cash":63.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN A PALMITATE 50000 UNITS/ML IM SOLN","drug_information":{"unit":"0.1","type":"ML"},"code_information":[{"code":"00000-0084-83","type":"NDC"}],"standard_charges":[{"gross_charge":130.59,"discounted_cash":65.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RALTEGRAVIR 400 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"00006-0227-61","type":"NDC"}],"standard_charges":[{"gross_charge":125.25,"discounted_cash":62.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UMECLIDINIUM 62.5 MCG/ACTUATION INHL DSDV","drug_information":{"unit":"7","type":"UN"},"code_information":[{"code":"00173-0873-06","type":"NDC"}],"standard_charges":[{"gross_charge":124.49,"discounted_cash":62.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL CHLORIDE 100 % TOP SPRA","drug_information":{"unit":"116","type":"ML"},"code_information":[{"code":"00386-0001-03","type":"NDC"}],"standard_charges":[{"gross_charge":126.22,"discounted_cash":63.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAXOLOL 0.5 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0245-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.2,"discounted_cash":64.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"62559-0190-16","type":"NDC"}],"standard_charges":[{"gross_charge":127.29,"discounted_cash":63.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M MEBROFENIN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"00270-0083-20","type":"NDC"}],"standard_charges":[{"gross_charge":127.04,"discounted_cash":63.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOBENATE DIMEGLUMINE 529 MG/ML (0.1 MMOL/0.2 ML) IV SOLN 20 ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"A9577","type":"HCPCS"},{"code":"00270-5164-15","type":"NDC"}],"standard_charges":[{"gross_charge":125.12,"discounted_cash":62.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B 0.1 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0285","type":"HCPCS"},{"code":"09999-9999-84","type":"NDC"}],"standard_charges":[{"gross_charge":131.63,"discounted_cash":65.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML IM S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"00548-5400-00","type":"NDC"}],"standard_charges":[{"gross_charge":127.2,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDROXYPROGESTERONE 150 MG/ML IM S.O.","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1050","type":"HCPCS"},{"code":"00548-5400-25","type":"NDC"}],"standard_charges":[{"gross_charge":127.2,"discounted_cash":63.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1750","type":"HCPCS"},{"code":"00023-6082-01","type":"NDC"}],"standard_charges":[{"gross_charge":128.96,"discounted_cash":64.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON DEXTRAN 50 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1750","type":"HCPCS"},{"code":"00023-6082-10","type":"NDC"}],"standard_charges":[{"gross_charge":128.96,"discounted_cash":64.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"00517-2340-01","type":"NDC"}],"standard_charges":[{"gross_charge":129.02,"discounted_cash":64.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 100 MG IRON/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"00517-2340-25","type":"NDC"}],"standard_charges":[{"gross_charge":129.02,"discounted_cash":64.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE 50 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2270","type":"HCPCS"},{"code":"00409-1134-05","type":"NDC"}],"standard_charges":[{"gross_charge":124.02,"discounted_cash":62.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"00008-4994-19","type":"NDC"}],"standard_charges":[{"gross_charge":128.14,"discounted_cash":64.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIGECYCLINE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3243","type":"HCPCS"},{"code":"00008-4994-20","type":"NDC"}],"standard_charges":[{"gross_charge":128.14,"discounted_cash":64.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZACITIDINE 100 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9025","type":"HCPCS"},{"code":"43598-0305-62","type":"NDC"}],"standard_charges":[{"gross_charge":130.85,"discounted_cash":65.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 1 MG/ML FOR DESENSITIZATION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"63323-0103-65","type":"NDC"}],"standard_charges":[{"gross_charge":124.8,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN FOR HIPEC SYRINGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"63323-0103-65","type":"NDC"}],"standard_charges":[{"gross_charge":124.8,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) IV SOLN FOR DESENSITIZATION","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"25021-0245-04","type":"NDC"}],"standard_charges":[{"gross_charge":127.19,"discounted_cash":63.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 160 MG/8 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"67457-0781-08","type":"NDC"}],"standard_charges":[{"gross_charge":132.07,"discounted_cash":66.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN 300 MG/15 ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9206","type":"HCPCS"},{"code":"55150-0354-01","type":"NDC"}],"standard_charges":[{"gross_charge":130.4,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN 200 ML *MULTI-DOSE* BTL","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-94","type":"NDC"}],"standard_charges":[{"gross_charge":124.8,"discounted_cash":62.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"470","type":"ML"},"code_information":[{"code":"00000-0039-86","type":"NDC"}],"standard_charges":[{"gross_charge":133.81,"discounted_cash":66.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOSI-FUSER 250 ML 2-DAY ELASTOMERIC PUMP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-81","type":"NDC"}],"standard_charges":[{"gross_charge":136.31,"discounted_cash":68.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOSI-FUSER 250 ML 5-DAY ELASTOMERIC PUMP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-83","type":"NDC"}],"standard_charges":[{"gross_charge":136.31,"discounted_cash":68.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOSI-FUSER 150 ML 2-DAY ELASTOMERIC PUMP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-87","type":"NDC"}],"standard_charges":[{"gross_charge":136.31,"discounted_cash":68.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 2 % TD OINT","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"00281-0326-30","type":"NDC"}],"standard_charges":[{"gross_charge":136.08,"discounted_cash":68.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00338-0519-14","type":"NDC"}],"standard_charges":[{"gross_charge":136.5,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN 250 MG/5 ML ORAL SOLN","drug_information":{"unit":"470","type":"ML"},"code_information":[{"code":"42192-0608-16","type":"NDC"}],"standard_charges":[{"gross_charge":133.81,"discounted_cash":66.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ILOPERIDONE  6 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43068-0106-02","type":"NDC"}],"standard_charges":[{"gross_charge":133.29,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ILOPERIDONE  8 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"43068-0108-02","type":"NDC"}],"standard_charges":[{"gross_charge":133.29,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID (BULK) 100 % MISC LIQD","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"51552-0209-06","type":"NDC"}],"standard_charges":[{"gross_charge":134.67,"discounted_cash":67.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE HCL (PF) 1 % (10 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"54288-0127-01","type":"NDC"}],"standard_charges":[{"gross_charge":136.27,"discounted_cash":68.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACAINE HCL (PF) 1 % (10 MG/ML) INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"54288-0127-10","type":"NDC"}],"standard_charges":[{"gross_charge":136.27,"discounted_cash":68.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOMETASONE  50 MCG/ACTUATION NASL SPRY","drug_information":{"unit":"17","type":"GR"},"code_information":[{"code":"60505-0830-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.21,"discounted_cash":66.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAT EMULSION 20 % IV EMUL","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"65219-0539-10","type":"NDC"}],"standard_charges":[{"gross_charge":136.5,"discounted_cash":68.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90714","type":"HCPCS"},{"code":"49281-0215-15","type":"NDC"}],"standard_charges":[{"gross_charge":135.18,"discounted_cash":67.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90714","type":"HCPCS"},{"code":"49281-0215-15","type":"NDC"}],"standard_charges":[{"gross_charge":135.18,"discounted_cash":67.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90714","type":"HCPCS"},{"code":"49281-0215-88","type":"NDC"}],"standard_charges":[{"gross_charge":135.18,"discounted_cash":67.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS AND DIPHTHER. TOX (PF) 5-2 LF UNIT/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90714","type":"HCPCS"},{"code":"49281-0215-88","type":"NDC"}],"standard_charges":[{"gross_charge":135.18,"discounted_cash":67.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUSS(ACEL),TET VAC(PF) 2 LF-(2.5-5-3-5 MCG)-5LF/0.5 ML IM SYRG S.O.","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90715","type":"HCPCS"},{"code":"49281-0400-15","type":"NDC"}],"standard_charges":[{"gross_charge":132.42,"discounted_cash":66.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOPICLENOL 0.5 MMOL/ML IV SOLN 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9573","type":"HCPCS"},{"code":"00270-7030-42","type":"NDC"}],"standard_charges":[{"gross_charge":133.88,"discounted_cash":66.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOXETATE 2.5 MMOL/10 ML IV SOLN 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9581","type":"HCPCS"},{"code":"50419-0320-01","type":"NDC"}],"standard_charges":[{"gross_charge":132.26,"discounted_cash":66.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOXETATE 2.5 MMOL/10 ML IV SOLN 10 ML VIAL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"A9581","type":"HCPCS"},{"code":"50419-0320-05","type":"NDC"}],"standard_charges":[{"gross_charge":132.26,"discounted_cash":66.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAMETHASONE ACET,SOD PHOS 6 MG/ML INJ SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0702","type":"HCPCS"},{"code":"00517-0720-01","type":"NDC"}],"standard_charges":[{"gross_charge":134.83,"discounted_cash":67.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 5 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"09999-9999-19","type":"NDC"}],"standard_charges":[{"gross_charge":135.49,"discounted_cash":67.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 6 MG/ML IV CONC","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"25021-0255-50","type":"NDC"}],"standard_charges":[{"gross_charge":135.92,"discounted_cash":67.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL 6 MG/ML IV CONC FOR DESENSITIZATION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9267","type":"HCPCS"},{"code":"25021-0255-50","type":"NDC"}],"standard_charges":[{"gross_charge":135.92,"discounted_cash":67.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 125 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0066-58","type":"NDC"}],"standard_charges":[{"gross_charge":142.16,"discounted_cash":71.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCONAZOLE 40 MG/ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"35","type":"ML"},"code_information":[{"code":"00000-0071-30","type":"NDC"}],"standard_charges":[{"gross_charge":142.92,"discounted_cash":71.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 180 MG ORAL TBER","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00187-3013-30","type":"NDC"}],"standard_charges":[{"gross_charge":139.27,"discounted_cash":69.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINO ACID 10 % 10 % IV SOLP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00264-1933-10","type":"NDC"}],"standard_charges":[{"gross_charge":142.35,"discounted_cash":71.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 20 MG/ML ORAL CONC","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"00406-8557-30","type":"NDC"}],"standard_charges":[{"gross_charge":140.4,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00409-7391-72","type":"NDC"}],"standard_charges":[{"gross_charge":138.94,"discounted_cash":69.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE 3 MMOL/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"00409-7391-82","type":"NDC"}],"standard_charges":[{"gross_charge":138.94,"discounted_cash":69.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00781-6022-52","type":"NDC"}],"standard_charges":[{"gross_charge":136.89,"discounted_cash":68.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERIT. DIALYSIS 13-2.5 % DEX CA 3.5 MEQ/L- MG 0.5 MEQ/L IP SOLN","drug_information":{"unit":"6000","type":"ML"},"code_information":[{"code":"00941-0413-01","type":"NDC"}],"standard_charges":[{"gross_charge":140.4,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE ORAL POWD","drug_information":{"unit":"454","type":"GR"},"code_information":[{"code":"11534-0166-44","type":"NDC"}],"standard_charges":[{"gross_charge":143.42,"discounted_cash":71.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOCINONIDE 0.05 % TOP OINT","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"51672-1264-03","type":"NDC"}],"standard_charges":[{"gross_charge":139.47,"discounted_cash":69.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENHYDRAMINE (BULK) MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"62991-1047-02","type":"NDC"}],"standard_charges":[{"gross_charge":140.4,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90715","type":"HCPCS"},{"code":"58160-0842-05","type":"NDC"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHTH,PERTUS(ACELL),TETANUS 2.5-8-5 LF-MCG-LF/0.5ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90715","type":"HCPCS"},{"code":"58160-0842-52","type":"NDC"}],"standard_charges":[{"gross_charge":136.59,"discounted_cash":68.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B 50 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0285","type":"HCPCS"},{"code":"39822-1055-05","type":"NDC"}],"standard_charges":[{"gross_charge":137.91,"discounted_cash":68.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"00409-8300-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR FOR IMPELLA (NO DOSE WARNING)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"00409-8300-00","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"71288-0427-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR FOR IMPELLA (NO DOSE WARNING)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"71288-0427-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"71288-0427-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG IV SOLR FOR IMPELLA (NO DOSE WARNING)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"71288-0427-11","type":"NDC"}],"standard_charges":[{"gross_charge":138.08,"discounted_cash":69.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN 5 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1364","type":"HCPCS"},{"code":"09999-9999-63","type":"NDC"}],"standard_charges":[{"gross_charge":141.18,"discounted_cash":70.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0013-05","type":"NDC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":71.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 250 MG/2 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0013-06","type":"NDC"}],"standard_charges":[{"gross_charge":143.56,"discounted_cash":71.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J2680","type":"HCPCS"},{"code":"25021-0838-05","type":"NDC"}],"standard_charges":[{"gross_charge":138.1,"discounted_cash":69.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 25 MG/ML INJ SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"61703-0408-41","type":"NDC"}],"standard_charges":[{"gross_charge":142.9,"discounted_cash":71.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOPOTECAN 4 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9351","type":"HCPCS"},{"code":"63323-0762-10","type":"NDC"}],"standard_charges":[{"gross_charge":138.73,"discounted_cash":69.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  3000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1306-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.54,"discounted_cash":71.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  3000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1306-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.54,"discounted_cash":71.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHOSUXIMIDE 250 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0100-45","type":"NDC"}],"standard_charges":[{"gross_charge":151.27,"discounted_cash":75.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHOSUXIMIDE 250 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-0670-16","type":"NDC"}],"standard_charges":[{"gross_charge":151.27,"discounted_cash":75.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODINE STRONG (LUGOLS) 5 % ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"38779-0598-08","type":"NDC"}],"standard_charges":[{"gross_charge":150.15,"discounted_cash":75.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILVER SULFADIAZINE 1 % TOP CREA","drug_information":{"unit":"400","type":"GR"},"code_information":[{"code":"43598-0210-40","type":"NDC"}],"standard_charges":[{"gross_charge":148.2,"discounted_cash":74.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMPANEL  6 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"69616-0276-30","type":"NDC"}],"standard_charges":[{"gross_charge":148.62,"discounted_cash":74.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL  1 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":145.2,"discounted_cash":72.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"71839-0137-01","type":"NDC"}],"standard_charges":[{"gross_charge":148.98,"discounted_cash":74.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"71839-0137-10","type":"NDC"}],"standard_charges":[{"gross_charge":148.98,"discounted_cash":74.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLDOPATE 250 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0210","type":"HCPCS"},{"code":"00517-8905-10","type":"NDC"}],"standard_charges":[{"gross_charge":146.24,"discounted_cash":73.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOBUTAMINE IN D5W 500 MG/250 ML (2,000 MCG/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1250","type":"HCPCS"},{"code":"00338-1075-02","type":"NDC"}],"standard_charges":[{"gross_charge":151.13,"discounted_cash":75.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOPROSTENOL 1.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1325","type":"HCPCS"},{"code":"62756-0060-40","type":"NDC"}],"standard_charges":[{"gross_charge":144.42,"discounted_cash":72.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIMAZOLAM 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2249","type":"HCPCS"},{"code":"71390-0011-00","type":"NDC"}],"standard_charges":[{"gross_charge":147.21,"discounted_cash":73.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIMAZOLAM 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2249","type":"HCPCS"},{"code":"71390-0011-11","type":"NDC"}],"standard_charges":[{"gross_charge":147.21,"discounted_cash":73.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TESTOSTERONE ENANTHATE 200 MG/ML IM OIL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J3121","type":"HCPCS"},{"code":"00143-9750-01","type":"NDC"}],"standard_charges":[{"gross_charge":150.39,"discounted_cash":75.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONIDASE, HUMAN RECOMB. 150 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3473","type":"HCPCS"},{"code":"18657-0117-01","type":"NDC"}],"standard_charges":[{"gross_charge":146.33,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONIDASE, HUMAN RECOMB. 150 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3473","type":"HCPCS"},{"code":"18657-0117-02","type":"NDC"}],"standard_charges":[{"gross_charge":146.33,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONIDASE, HUMAN RECOMB. 150 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3473","type":"HCPCS"},{"code":"18657-0117-04","type":"NDC"}],"standard_charges":[{"gross_charge":146.33,"discounted_cash":73.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G SODIUM 5 MILLION UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00781-6153-94","type":"NDC"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G SODIUM 5 MILLION UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00781-6153-95","type":"NDC"}],"standard_charges":[{"gross_charge":145.4,"discounted_cash":72.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"00000-0075-95","type":"NDC"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"00121-0759-08","type":"NDC"}],"standard_charges":[{"gross_charge":144.2,"discounted_cash":72.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDARABINE 50 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"63323-0192-02","type":"NDC"}],"standard_charges":[{"gross_charge":150.15,"discounted_cash":75.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  4000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1307-01","type":"NDC"}],"standard_charges":[{"gross_charge":143.68,"discounted_cash":71.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX  4000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1307-10","type":"NDC"}],"standard_charges":[{"gross_charge":143.68,"discounted_cash":71.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 51 % IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00270-1317-02","type":"NDC"}],"standard_charges":[{"gross_charge":148.4,"discounted_cash":74.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOXAGLATE MEGLUMINE & SODIUM 39.3-19.6 % INJ SOLN 10 ML VIAL","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"09999-9901-88","type":"NDC"}],"standard_charges":[{"gross_charge":148.08,"discounted_cash":74.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IODIXANOL 320 MG IODINE/ML IV SOLN 150 ML BTL","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"65219-0383-50","type":"NDC"}],"standard_charges":[{"gross_charge":151.2,"discounted_cash":75.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFIXIME 100 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0050-75","type":"NDC"}],"standard_charges":[{"gross_charge":163.61,"discounted_cash":81.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG/ML ORAL CONC (ANY SIZE)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00000-0110-94","type":"NDC"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARGININE 10% CONTINUOUS INFUSION","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"00009-0436-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.1,"discounted_cash":76.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARGININE HCL (L-ARGININE) 10 % IV SOLP","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"00009-0436-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.1,"discounted_cash":76.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG/ML ORAL CONC (BULK)","drug_information":{"unit":"1000","type":"ML"},"code_information":[{"code":"00406-0527-10","type":"NDC"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 25 MG/ML INTRAVITREAL","drug_information":{"unit":"0.2","type":"ML"},"code_information":[{"code":"09999-9966-01","type":"NDC"}],"standard_charges":[{"gross_charge":155.41,"discounted_cash":77.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTAMIDINE 300 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"23155-0748-31","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":81.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTAMIDINE 300 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"23155-0748-41","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":81.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-CHLORPHENIRAMINE 10-8 MG/5 ML ORAL SU12","drug_information":{"unit":"115","type":"ML"},"code_information":[{"code":"27808-0086-01","type":"NDC"}],"standard_charges":[{"gross_charge":152.49,"discounted_cash":76.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METOCLOPRAMIDE (BULK) MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"62991-2042-02","type":"NDC"}],"standard_charges":[{"gross_charge":152.1,"discounted_cash":76.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFIXIME 100 MG/5 ML ORAL SUSR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"68180-0405-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.61,"discounted_cash":81.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PILOCARPINE HCL  4 % OPHT DROP","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"70069-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":159.71,"discounted_cash":79.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M SESTAMIBI - CARDIOLITE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9500","type":"HCPCS"},{"code":"65857-0600-20","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP OF TC-99M-TETROFOSMIN 0.23 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9502","type":"HCPCS"},{"code":"17156-0024-05","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP OF TC-99M-TETROFOSMIN 0.23 MG IV SOLR STRESS DOSE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9502","type":"HCPCS"},{"code":"17156-0024-05","type":"NDC"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUCOVORIN CALCIUM 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0640","type":"HCPCS"},{"code":"63323-0711-00","type":"NDC"}],"standard_charges":[{"gross_charge":163.49,"discounted_cash":81.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROTAMINE 10 MG/ML IV SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J2720","type":"HCPCS"},{"code":"63323-0229-30","type":"NDC"}],"standard_charges":[{"gross_charge":158.44,"discounted_cash":79.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIFENTANIL 1 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9391-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":81.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMIFENTANIL 1 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00143-9391-10","type":"NDC"}],"standard_charges":[{"gross_charge":163.52,"discounted_cash":81.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 10 MG/ML IV SOLN","drug_information":{"unit":"45","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"55150-0335-01","type":"NDC"}],"standard_charges":[{"gross_charge":155.32,"discounted_cash":77.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNORUBICIN 5 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9150","type":"HCPCS"},{"code":"42658-0021-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.47,"discounted_cash":79.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNORUBICIN 5 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9150","type":"HCPCS"},{"code":"42658-0021-02","type":"NDC"}],"standard_charges":[{"gross_charge":158.47,"discounted_cash":79.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 20 MG/ML IV SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"00143-9511-01","type":"NDC"}],"standard_charges":[{"gross_charge":161.27,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOTREXATE SODIUM (PF) 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9260","type":"HCPCS"},{"code":"00143-9830-01","type":"NDC"}],"standard_charges":[{"gross_charge":158.54,"discounted_cash":79.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML IV SUSP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"11994-0011-01","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERFLUTREN LIPID MICROSPHERES 1.1 MG/ML IV SUSP","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"Q9957","type":"HCPCS"},{"code":"11994-0011-04","type":"NDC"}],"standard_charges":[{"gross_charge":156.25,"discounted_cash":78.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 2 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0039-50","type":"NDC"}],"standard_charges":[{"gross_charge":166.03,"discounted_cash":83.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"00000-0077-97","type":"NDC"}],"standard_charges":[{"gross_charge":168.48,"discounted_cash":84.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (RECOMBINANT)  5000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00338-0322-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.88,"discounted_cash":81.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (RECOMBINANT)  5000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00338-0324-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.88,"discounted_cash":81.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SOD PHOS DIBASIC, HEPT (BULK) MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"06299-1137-62","type":"NDC"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE 10 MG/ML IO SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"08544-5083-81","type":"NDC"}],"standard_charges":[{"gross_charge":171.37,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN SPONGE,ABSORB-PORCINE 100 TOP SPGE","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"09999-9996-08","type":"NDC"}],"standard_charges":[{"gross_charge":164.25,"discounted_cash":82.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-GRAMICIDIN 1.75 MG-10,000 UNIT-0.025MG/ML OPHT DROP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"24208-0790-62","type":"NDC"}],"standard_charges":[{"gross_charge":165.13,"discounted_cash":82.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 40 % (W/V), 30% (W/W) ORAL PSTE 230 ML *MULTI-DOSE* TUBE","drug_information":{"unit":"230","type":"ML"},"code_information":[{"code":"32909-0125-22","type":"NDC"}],"standard_charges":[{"gross_charge":169.28,"discounted_cash":84.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE-CITRIC ACID 490-640 MG/5 ML ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"46287-0014-01","type":"NDC"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBAMAZEPINE 100 MG/5 ML ORAL SUSP","drug_information":{"unit":"450","type":"ML"},"code_information":[{"code":"51672-4047-09","type":"NDC"}],"standard_charges":[{"gross_charge":168.48,"discounted_cash":84.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALOXONE 4 MG/ACTUATION NASL SPRY","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"69547-0627-02","type":"NDC"}],"standard_charges":[{"gross_charge":167.68,"discounted_cash":83.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"58160-0821-43","type":"NDC"}],"standard_charges":[{"gross_charge":166.73,"discounted_cash":83.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VIRUS VACC.REC(PF) 20 MCG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"58160-0821-52","type":"NDC"}],"standard_charges":[{"gross_charge":166.73,"discounted_cash":83.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIODARONE IN DEXTROSE,ISO-OSM 360 MG/200 ML (1.8 MG/ML) IV SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J0283","type":"HCPCS"},{"code":"43066-0360-20","type":"NDC"}],"standard_charges":[{"gross_charge":167.7,"discounted_cash":83.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENOXAPARIN 20 MG/ML SC SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1650","type":"HCPCS"},{"code":"09999-7001-05","type":"NDC"}],"standard_charges":[{"gross_charge":167.33,"discounted_cash":83.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNIT/ML SUBQ SOLN - GLUCOMMANDER","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":171.1,"discounted_cash":85.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN LISPRO 100 UNITS/ML SUBQ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-7510-01","type":"NDC"}],"standard_charges":[{"gross_charge":171.1,"discounted_cash":85.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOXIFLOXACIN-SOD.CHLORIDE(ISO) 400 MG/250 ML IV PGBK","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J2280","type":"HCPCS"},{"code":"67457-0323-25","type":"NDC"}],"standard_charges":[{"gross_charge":166.73,"discounted_cash":83.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 500 MG/4 ML IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0003-02","type":"NDC"}],"standard_charges":[{"gross_charge":168.45,"discounted_cash":84.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 10 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"09999-9999-03","type":"NDC"}],"standard_charges":[{"gross_charge":163.8,"discounted_cash":81.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN SYRINGE 25% - NICU","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"00944-0493-01","type":"NDC"}],"standard_charges":[{"gross_charge":169.07,"discounted_cash":84.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00270-1316-35","type":"NDC"}],"standard_charges":[{"gross_charge":170.8,"discounted_cash":85.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN 150 ML  BTL","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-03","type":"NDC"}],"standard_charges":[{"gross_charge":170.4,"discounted_cash":85.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIOTROPIUM BROMIDE 18 MCG INHL CPDV","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"00597-0075-75","type":"NDC"}],"standard_charges":[{"gross_charge":173.32,"discounted_cash":86.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CITRATE (BULK) 100 % MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"06299-1170-02","type":"NDC"}],"standard_charges":[{"gross_charge":175.5,"discounted_cash":87.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE 10 MG/ML IO SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"08065-1830-04","type":"NDC"}],"standard_charges":[{"gross_charge":171.37,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"24208-0720-02","type":"NDC"}],"standard_charges":[{"gross_charge":182.17,"discounted_cash":91.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 40 % (W/V) 29% (W/W) ORAL SUSP 250 ML *MULTI-DOSE* BTL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"32909-0122-07","type":"NDC"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BREXPIPRAZOLE 0.5 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59148-0036-13","type":"NDC"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BREXPIPRAZOLE 1 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59148-0037-13","type":"NDC"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BREXPIPRAZOLE 2 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59148-0038-13","type":"NDC"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BREXPIPRAZOLE 3 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59148-0039-13","type":"NDC"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BREXPIPRAZOLE 4 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"59148-0040-13","type":"NDC"}],"standard_charges":[{"gross_charge":178.24,"discounted_cash":89.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARIPRAZINE 1.5 MG ORAL CAP","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"61874-0115-20","type":"NDC"}],"standard_charges":[{"gross_charge":175.13,"discounted_cash":87.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARIPRAZINE 3 MG ORAL CAP","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"61874-0130-20","type":"NDC"}],"standard_charges":[{"gross_charge":175.13,"discounted_cash":87.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARIPRAZINE 4.5 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"61874-0145-30","type":"NDC"}],"standard_charges":[{"gross_charge":175.13,"discounted_cash":87.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARIPRAZINE 6 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"61874-0160-30","type":"NDC"}],"standard_charges":[{"gross_charge":175.13,"discounted_cash":87.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"63323-0402-03","type":"NDC"}],"standard_charges":[{"gross_charge":178.02,"discounted_cash":89.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AZTREONAM 2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0457","type":"HCPCS"},{"code":"63323-0402-20","type":"NDC"}],"standard_charges":[{"gross_charge":178.02,"discounted_cash":89.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIMETHOBENZAMIDE 100 MG/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J3250","type":"HCPCS"},{"code":"42023-0119-25","type":"NDC"}],"standard_charges":[{"gross_charge":176.05,"discounted_cash":88.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3480","type":"HCPCS"},{"code":"00264-1944-20","type":"NDC"}],"standard_charges":[{"gross_charge":181.35,"discounted_cash":90.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN (5 MG/ML) IV SOLN FOR DESENSITIZATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"70860-0201-10","type":"NDC"}],"standard_charges":[{"gross_charge":183.07,"discounted_cash":91.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN  5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"72819-0152-05","type":"NDC"}],"standard_charges":[{"gross_charge":178.43,"discounted_cash":89.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMETREXED DISODIUM  500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9305","type":"HCPCS"},{"code":"71288-0167-50","type":"NDC"}],"standard_charges":[{"gross_charge":178.35,"discounted_cash":89.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN SYRINGE 5% - NICU","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"P9045","type":"HCPCS"},{"code":"00944-0495-05","type":"NDC"}],"standard_charges":[{"gross_charge":176.48,"discounted_cash":88.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00000-0040-50","type":"NDC"}],"standard_charges":[{"gross_charge":191.92,"discounted_cash":95.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0040-65","type":"NDC"}],"standard_charges":[{"gross_charge":187.2,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00000-0041-38","type":"NDC"}],"standard_charges":[{"gross_charge":192.44,"discounted_cash":96.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENYTOIN 100 MG CAPSULE #30 ED PACK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00000-0045-33","type":"NDC"}],"standard_charges":[{"gross_charge":188.16,"discounted_cash":94.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZEPAM 5 MG/5 ML (1 MG/ML) ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00054-3188-63","type":"NDC"}],"standard_charges":[{"gross_charge":187.2,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIDAZOLAM 2 MG/ML ORAL SYRP","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"00054-3566-99","type":"NDC"}],"standard_charges":[{"gross_charge":191.92,"discounted_cash":95.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LAMIVUDINE 10 MG/ML ORAL SOLN","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"57237-0274-24","type":"NDC"}],"standard_charges":[{"gross_charge":192.44,"discounted_cash":96.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRYPAN BLUE 0.06 % IO SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"68803-0612-10","type":"NDC"}],"standard_charges":[{"gross_charge":191.88,"discounted_cash":95.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G ORAL PACK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70700-0268-94","type":"NDC"}],"standard_charges":[{"gross_charge":191.42,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3G ORAL PACK PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70700-0268-94","type":"NDC"}],"standard_charges":[{"gross_charge":191.42,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3 G ORAL PACK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70700-0268-99","type":"NDC"}],"standard_charges":[{"gross_charge":191.42,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSFOMYCIN TROMETHAMINE 3G ORAL PACK PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70700-0268-99","type":"NDC"}],"standard_charges":[{"gross_charge":191.42,"discounted_cash":95.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARBITAL 10 MG/ML IV SYRINGE - PED/NICU STEP 2","drug_information":{"unit":"13","type":"ML"},"code_information":[{"code":"J2560","type":"HCPCS"},{"code":"09999-9999-33","type":"NDC"}],"standard_charges":[{"gross_charge":184.05,"discounted_cash":92.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXAPRAM 20 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00641-6018-01","type":"NDC"}],"standard_charges":[{"gross_charge":192.51,"discounted_cash":96.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML(6.7MG/5ML) ORAL(ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"00000-0071-87","type":"NDC"}],"standard_charges":[{"gross_charge":192.89,"discounted_cash":96.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 5 MG BASE/5 ML(6.7MG/5ML) ORAL(ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"J7510","type":"HCPCS"},{"code":"13925-0166-04","type":"NDC"}],"standard_charges":[{"gross_charge":192.89,"discounted_cash":96.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"68382-0997-01","type":"NDC"}],"standard_charges":[{"gross_charge":190.84,"discounted_cash":95.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARSENIC TRIOXIDE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9017","type":"HCPCS"},{"code":"68382-0997-10","type":"NDC"}],"standard_charges":[{"gross_charge":190.84,"discounted_cash":95.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 10 MG/ML IV SOLN FOR DESENSITIZATION","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"00703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":185.8,"discounted_cash":92.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN FOR HIPEC SYRINGE","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"63323-0172-60","type":"NDC"}],"standard_charges":[{"gross_charge":183.23,"discounted_cash":91.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"81298-8110-01","type":"NDC"}],"standard_charges":[{"gross_charge":188.96,"discounted_cash":94.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"00143-9279-01","type":"NDC"}],"standard_charges":[{"gross_charge":190.84,"discounted_cash":95.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 300 MG IODINE/ML IV SOLN UD SYRINGES","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"99999-0300-20","type":"NDC"}],"standard_charges":[{"gross_charge":193.04,"discounted_cash":96.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARENTERAL AMINO ACID 10% NO.6 10 % IV SOLP","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"00338-0644-06","type":"NDC"}],"standard_charges":[{"gross_charge":197.6,"discounted_cash":98.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 234 MG/ML (4 MEQ/ML) ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"04843-3215-01","type":"NDC"}],"standard_charges":[{"gross_charge":201.31,"discounted_cash":100.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRICHLOROACETIC ACID  85 % TOP SOLR","drug_information":{"unit":"28.35","type":"GR"},"code_information":[{"code":"09999-9997-42","type":"NDC"}],"standard_charges":[{"gross_charge":202.43,"discounted_cash":101.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLVAPTAN 15 MG ORAL TAB","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"31722-0868-03","type":"NDC"}],"standard_charges":[{"gross_charge":199.05,"discounted_cash":99.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOLVAPTAN 15 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"31722-0868-31","type":"NDC"}],"standard_charges":[{"gross_charge":199.05,"discounted_cash":99.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARIUM SULFATE 40 %(W/V), 29% (W/W)(1500 CPS) ORAL SUSP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"32909-0121-07","type":"NDC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (BOVINE)  5000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60793-0215-05","type":"NDC"}],"standard_charges":[{"gross_charge":199.2,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (BOVINE)  5000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60793-0315-01","type":"NDC"}],"standard_charges":[{"gross_charge":199.2,"discounted_cash":99.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAXIMIN 550 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"65649-0303-03","type":"NDC"}],"standard_charges":[{"gross_charge":199.69,"discounted_cash":99.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"71225-0126-03","type":"NDC"}],"standard_charges":[{"gross_charge":201.78,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE IN 0.9 % NACL 400 MCG/100 ML (4 MCG/ML) IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"71225-0126-06","type":"NDC"}],"standard_charges":[{"gross_charge":201.78,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 5 MG/ML CONTINUOUS NEB - AEROGEN SYRINGE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"73177-0146-33","type":"NDC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUTEROL SULFATE 5 MG/ML INHL NEBU","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"73177-0146-33","type":"NDC"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":97.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLU VACC TS2024-25(65YR UP)-PF 180 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90662","type":"HCPCS"},{"code":"49281-0124-65","type":"NDC"}],"standard_charges":[{"gross_charge":196.73,"discounted_cash":98.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLU VACC TS2024-25(65YR UP)-PF 180 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90662","type":"HCPCS"},{"code":"49281-0124-88","type":"NDC"}],"standard_charges":[{"gross_charge":196.73,"discounted_cash":98.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT FOR TC 99M-SOD THIOSULFATE 2 MG MISC SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9541","type":"HCPCS"},{"code":"45567-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.8,"discounted_cash":96.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0173","type":"HCPCS"},{"code":"54288-0120-01","type":"NDC"}],"standard_charges":[{"gross_charge":193.83,"discounted_cash":96.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  2000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0302-00","type":"NDC"}],"standard_charges":[{"gross_charge":194.08,"discounted_cash":97.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  2000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":194.08,"discounted_cash":97.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  2000 UNITS INJ SOLN PARTIAL DOSE / NICU","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0302-01","type":"NDC"}],"standard_charges":[{"gross_charge":194.08,"discounted_cash":97.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARBOPLATIN 10 MG/ML IV SOLN","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"J9045","type":"HCPCS"},{"code":"00703-4239-01","type":"NDC"}],"standard_charges":[{"gross_charge":201.78,"discounted_cash":100.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 1 MG/ML IV SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"63323-0103-64","type":"NDC"}],"standard_charges":[{"gross_charge":196.84,"discounted_cash":98.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDARUBICIN 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9211","type":"HCPCS"},{"code":"00143-9218-01","type":"NDC"}],"standard_charges":[{"gross_charge":196.24,"discounted_cash":98.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VINBLASTINE 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9360","type":"HCPCS"},{"code":"63323-0278-10","type":"NDC"}],"standard_charges":[{"gross_charge":193.37,"discounted_cash":96.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5 ML IM SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9395","type":"HCPCS"},{"code":"43598-0262-11","type":"NDC"}],"standard_charges":[{"gross_charge":194.11,"discounted_cash":97.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FULVESTRANT 250 MG/5 ML IM SYRG","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9395","type":"HCPCS"},{"code":"43598-0262-23","type":"NDC"}],"standard_charges":[{"gross_charge":194.11,"discounted_cash":97.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 40 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0039-07","type":"NDC"}],"standard_charges":[{"gross_charge":205.2,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSP (ANY SIZE)","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"00000-0061-19","type":"NDC"}],"standard_charges":[{"gross_charge":207.94,"discounted_cash":103.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0093-75","type":"NDC"}],"standard_charges":[{"gross_charge":220.78,"discounted_cash":110.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROPRANOLOL 40 MG/5 ML (8 MG/ML) ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00054-3730-63","type":"NDC"}],"standard_charges":[{"gross_charge":205.2,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZANAMIVIR 5 MG/ACTUATION INHL DSDV","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"00173-0681-01","type":"NDC"}],"standard_charges":[{"gross_charge":217.68,"discounted_cash":108.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANOLIN (BULK) MISC WAX","drug_information":{"unit":"1000","type":"GR"},"code_information":[{"code":"03877-9010-59","type":"NDC"}],"standard_charges":[{"gross_charge":205.2,"discounted_cash":102.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITRATE DEXTROSE SOLUTION 50 ML","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"23731-6053-05","type":"NDC"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":104.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE BITARTRATE (BULK) MISC POWD","drug_information":{"unit":"0.18","type":"GR"},"code_information":[{"code":"51552-0454-09","type":"NDC"}],"standard_charges":[{"gross_charge":206.67,"discounted_cash":103.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 250-62.5 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"59651-0026-01","type":"NDC"}],"standard_charges":[{"gross_charge":220.78,"discounted_cash":110.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEGESTROL 400 MG/10 ML (40 MG/ML) ORAL SUSP","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"64380-0160-02","type":"NDC"}],"standard_charges":[{"gross_charge":207.94,"discounted_cash":103.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET,POL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90696","type":"HCPCS"},{"code":"49281-0562-10","type":"NDC"}],"standard_charges":[{"gross_charge":211.79,"discounted_cash":105.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPH,PERTUS(ACEL),TET,POL (PF) 15 LF-48 MCG- 5 LF UNIT/0.5ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90696","type":"HCPCS"},{"code":"49281-0562-58","type":"NDC"}],"standard_charges":[{"gross_charge":211.79,"discounted_cash":105.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM IODIDE-123 ORAL CAP *DIAGNOSTIC*","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9516","type":"HCPCS"},{"code":"09999-9900-99","type":"NDC"}],"standard_charges":[{"gross_charge":217.8,"discounted_cash":108.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP OF TC-99M-MEBROFENIN 45 MG IV SOLR","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"A9537","type":"HCPCS"},{"code":"45567-0455-01","type":"NDC"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M SULFUR COLLOID","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9541","type":"HCPCS"},{"code":"09999-9955-66","type":"NDC"}],"standard_charges":[{"gross_charge":203.99,"discounted_cash":102.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE  500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1364","type":"HCPCS"},{"code":"00409-6482-01","type":"NDC"}],"standard_charges":[{"gross_charge":203.23,"discounted_cash":101.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN LACTOBIONATE  500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1364","type":"HCPCS"},{"code":"00409-6482-11","type":"NDC"}],"standard_charges":[{"gross_charge":203.23,"discounted_cash":101.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLARGINE 100 UNITS/ML SUBQ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00088-2220-33","type":"NDC"}],"standard_charges":[{"gross_charge":217.17,"discounted_cash":108.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLARGINE 100 UNITS/ML VIAL CPU FOR GLUCOMMANDER","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9997-32","type":"NDC"}],"standard_charges":[{"gross_charge":217.17,"discounted_cash":108.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SOD SUC(PF) 1000 MG/8 ML IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0018-20","type":"NDC"}],"standard_charges":[{"gross_charge":213.41,"discounted_cash":106.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL 160-4.5 MCG/ACTUATION INHL HFAA","drug_information":{"unit":"6","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00186-0370-28","type":"NDC"}],"standard_charges":[{"gross_charge":216.03,"discounted_cash":108.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE-FORMOTEROL 80-4.5 MCG/ACTUATION INHL HFAA","drug_information":{"unit":"6.9","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00186-0372-28","type":"NDC"}],"standard_charges":[{"gross_charge":216.03,"discounted_cash":108.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT  40 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"13668-0591-80","type":"NDC"}],"standard_charges":[{"gross_charge":209.42,"discounted_cash":104.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT  40 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"13668-0591-81","type":"NDC"}],"standard_charges":[{"gross_charge":209.42,"discounted_cash":104.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT  40 MG ORAL CAP","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"13668-0591-82","type":"NDC"}],"standard_charges":[{"gross_charge":209.42,"discounted_cash":104.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN 2 MG/ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00069-1542-20","type":"NDC"}],"standard_charges":[{"gross_charge":221.54,"discounted_cash":110.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN CHEMO SYRINGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00069-3034-20","type":"NDC"}],"standard_charges":[{"gross_charge":221.54,"discounted_cash":110.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN CHEMO SYRINGE - PEDIATRIC","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00069-3034-20","type":"NDC"}],"standard_charges":[{"gross_charge":221.54,"discounted_cash":110.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL 5 G/100 ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"16729-0276-38","type":"NDC"}],"standard_charges":[{"gross_charge":210.14,"discounted_cash":105.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROURACIL CHEMO SYRINGE","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9190","type":"HCPCS"},{"code":"16729-0276-38","type":"NDC"}],"standard_charges":[{"gross_charge":210.14,"discounted_cash":105.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2-0.1037 -0.0194 MG/5 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0105-88","type":"NDC"}],"standard_charges":[{"gross_charge":221.62,"discounted_cash":110.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN SPONGE,ABSORBABLE TOP SYRG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00009-1040-01","type":"NDC"}],"standard_charges":[{"gross_charge":225.18,"discounted_cash":112.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN SPONGE,ABSORBABLE TOP SYRG","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"00009-1040-06","type":"NDC"}],"standard_charges":[{"gross_charge":225.18,"discounted_cash":112.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5 ML ORAL LIQD","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00054-3194-46","type":"NDC"}],"standard_charges":[{"gross_charge":232.34,"discounted_cash":116.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLINDAMYCIN PHOSPHATE 2 % VAGL CREA","drug_information":{"unit":"40","type":"GR"},"code_information":[{"code":"00168-0277-40","type":"NDC"}],"standard_charges":[{"gross_charge":229.98,"discounted_cash":114.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM ALUM (BULK) MISC POWD","drug_information":{"unit":"10","type":"GR"},"code_information":[{"code":"02435-7300-30","type":"NDC"}],"standard_charges":[{"gross_charge":230.13,"discounted_cash":115.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE 10 MG/ML IO SYRG","drug_information":{"unit":"0.55","type":"ML"},"code_information":[{"code":"08544-5085-81","type":"NDC"}],"standard_charges":[{"gross_charge":229.59,"discounted_cash":114.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYUREA 100 MG/ML SUSPENSION 500 ML (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"09999-9998-92","type":"NDC"}],"standard_charges":[{"gross_charge":228.0,"discounted_cash":114.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENOBARB-HYOSCY-ATROPINE-SCOP 16.2-0.1037 -0.0194 MG/5 ML ORAL ELIX","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"50742-0666-04","type":"NDC"}],"standard_charges":[{"gross_charge":221.62,"discounted_cash":110.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE HCL 1 MG/ML NASL SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"54288-0123-01","type":"NDC"}],"standard_charges":[{"gross_charge":230.13,"discounted_cash":115.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYPROMELLOSE 2 % IO SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"57770-5501-00","type":"NDC"}],"standard_charges":[{"gross_charge":224.77,"discounted_cash":112.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACTUATION NASL SPRY","drug_information":{"unit":"3.7","type":"ML"},"code_information":[{"code":"60505-0823-06","type":"NDC"}],"standard_charges":[{"gross_charge":232.19,"discounted_cash":116.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (BOVINE)  5000 UNITS NASL NSSY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60793-0205-05","type":"NDC"}],"standard_charges":[{"gross_charge":232.56,"discounted_cash":116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN GLARGINE 100 UNITS/ML VIAL CPU","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9997-32","type":"NDC"}],"standard_charges":[{"gross_charge":228.6,"discounted_cash":114.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NICARDIPINE 40 MG/200 ML (200 MCG/ML) INFUSION","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J2404","type":"HCPCS"},{"code":"43066-0016-10","type":"NDC"}],"standard_charges":[{"gross_charge":222.68,"discounted_cash":111.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTAMIDINE 300 MG INHL SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2545","type":"HCPCS"},{"code":"13925-0522-01","type":"NDC"}],"standard_charges":[{"gross_charge":230.93,"discounted_cash":115.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCAINAMIDE 100 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"00409-1902-01","type":"NDC"}],"standard_charges":[{"gross_charge":229.41,"discounted_cash":114.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCAINAMIDE 100 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"00409-1902-11","type":"NDC"}],"standard_charges":[{"gross_charge":229.41,"discounted_cash":114.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIROFIBAN-0.9% SODIUM CHLORIDE 5 MG/100 ML (50 MCG/ML) IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"25208-0002-01","type":"NDC"}],"standard_charges":[{"gross_charge":230.28,"discounted_cash":115.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80 MG/8 ML (10 MG/ML) IV SOLN","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"67457-0532-08","type":"NDC"}],"standard_charges":[{"gross_charge":221.86,"discounted_cash":110.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 25 % 25 % IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"44206-0251-10","type":"NDC"}],"standard_charges":[{"gross_charge":227.24,"discounted_cash":113.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN, HUMAN 25 % 25 % IV SOLP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"44206-0251-91","type":"NDC"}],"standard_charges":[{"gross_charge":227.24,"discounted_cash":113.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 51 % IV SOLN","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9966","type":"HCPCS"},{"code":"00270-1317-09","type":"NDC"}],"standard_charges":[{"gross_charge":222.6,"discounted_cash":111.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"00000-0040-63","type":"NDC"}],"standard_charges":[{"gross_charge":241.37,"discounted_cash":120.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN  50 MCG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0055-01","type":"NDC"}],"standard_charges":[{"gross_charge":238.95,"discounted_cash":119.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 200 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0067-56","type":"NDC"}],"standard_charges":[{"gross_charge":235.46,"discounted_cash":117.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALANCED SALT SOLN NO.1 IRRIG. IO SOLN","drug_information":{"unit":"480","type":"ML"},"code_information":[{"code":"00065-0800-94","type":"NDC"}],"standard_charges":[{"gross_charge":233.48,"discounted_cash":116.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVOFLURANE INHL LIQD","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00074-4456-51","type":"NDC"}],"standard_charges":[{"gross_charge":239.4,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UMECLIDINIUM-VILANTEROL 62.5-25 MCG/ACTUATION INHL DSDV","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"00173-0869-06","type":"NDC"}],"standard_charges":[{"gross_charge":241.92,"discounted_cash":120.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM POLYSTYRENE SULFONATE 15 GRAM/60 ML RETENTION ENEMA","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00574-2003-16","type":"NDC"}],"standard_charges":[{"gross_charge":237.26,"discounted_cash":118.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00603-1161-58","type":"NDC"}],"standard_charges":[{"gross_charge":242.65,"discounted_cash":121.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOPROSTENOL (VELETRI) 20 MCG/ML INHALATION - AEROGEN CNR","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9992-87","type":"NDC"}],"standard_charges":[{"gross_charge":234.08,"discounted_cash":117.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAFENIDE ACETATE 85 MG/G TOP CREA","drug_information":{"unit":"56.7","type":"GR"},"code_information":[{"code":"16571-0723-60","type":"NDC"}],"standard_charges":[{"gross_charge":242.4,"discounted_cash":121.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUOROMETHOLONE 0.1 % OPHT DRPS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"60758-0880-05","type":"NDC"}],"standard_charges":[{"gross_charge":238.76,"discounted_cash":119.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE 250 MG/5 ML ORAL SUSP","drug_information":{"unit":"237","type":"ML"},"code_information":[{"code":"65649-0311-12","type":"NDC"}],"standard_charges":[{"gross_charge":241.37,"discounted_cash":120.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 50 MCG/ML (0.05 MG/ML) ORAL SOLN","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"66689-0327-02","type":"NDC"}],"standard_charges":[{"gross_charge":238.95,"discounted_cash":119.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SEVOFLURANE INHL LIQD","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"66794-0015-25","type":"NDC"}],"standard_charges":[{"gross_charge":239.4,"discounted_cash":119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEP B-DP(A)T-POLIO VAC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90723","type":"HCPCS"},{"code":"58160-0811-43","type":"NDC"}],"standard_charges":[{"gross_charge":234.89,"discounted_cash":117.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEP B-DP(A)T-POLIO VAC (PF) 10 MCG-25LF-25 MCG-10LF/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90723","type":"HCPCS"},{"code":"58160-0811-52","type":"NDC"}],"standard_charges":[{"gross_charge":234.89,"discounted_cash":117.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM IODIDE-123 3.7 MBQ (100 MICROCI) ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9516","type":"HCPCS"},{"code":"17156-0201-05","type":"NDC"}],"standard_charges":[{"gross_charge":234.24,"discounted_cash":117.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERAVACYCLINE  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0122","type":"HCPCS"},{"code":"71773-0050-01","type":"NDC"}],"standard_charges":[{"gross_charge":233.69,"discounted_cash":116.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERAVACYCLINE  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0122","type":"HCPCS"},{"code":"71773-0050-05","type":"NDC"}],"standard_charges":[{"gross_charge":233.69,"discounted_cash":116.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERAVACYCLINE  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0122","type":"HCPCS"},{"code":"71773-0050-12","type":"NDC"}],"standard_charges":[{"gross_charge":233.69,"discounted_cash":116.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOTHYROXINE 100 MCG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0650","type":"HCPCS"},{"code":"42023-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":237.24,"discounted_cash":118.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  4000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"55513-0148-01","type":"NDC"}],"standard_charges":[{"gross_charge":240.77,"discounted_cash":120.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  4000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"55513-0148-10","type":"NDC"}],"standard_charges":[{"gross_charge":240.77,"discounted_cash":120.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 250 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7516","type":"HCPCS"},{"code":"00078-0109-01","type":"NDC"}],"standard_charges":[{"gross_charge":242.22,"discounted_cash":121.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE 250 MG/5 ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7516","type":"HCPCS"},{"code":"00078-0109-61","type":"NDC"}],"standard_charges":[{"gross_charge":242.22,"discounted_cash":121.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACYCLOVIR 200 MG/5 ML ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"31722-0681-47","type":"NDC"}],"standard_charges":[{"gross_charge":235.46,"discounted_cash":117.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DICYCLOMINE 10 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0039-54","type":"NDC"}],"standard_charges":[{"gross_charge":242.65,"discounted_cash":121.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COBALT BONE CEMENT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00040-2282-03","type":"NDC"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 0.6 MG SL SUBL","drug_information":{"unit":"100","type":"UN"},"code_information":[{"code":"00071-0419-24","type":"NDC"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRAVOPROST 0.004 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"00378-9651-32","type":"NDC"}],"standard_charges":[{"gross_charge":253.35,"discounted_cash":126.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENTHOL (BULK) MISC CRYS","drug_information":{"unit":"120","type":"GR"},"code_information":[{"code":"00395-1619-94","type":"NDC"}],"standard_charges":[{"gross_charge":251.26,"discounted_cash":125.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM CHLORIDE 4 MEQ/ML SOLUTION 30 ML","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"04843-3215-01","type":"NDC"}],"standard_charges":[{"gross_charge":249.84,"discounted_cash":124.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILDENAFIL (PULM.HYPERTENSION) 10 MG/ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"112","type":"ML"},"code_information":[{"code":"09999-9998-37","type":"NDC"}],"standard_charges":[{"gross_charge":243.02,"discounted_cash":121.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"24201-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":247.84,"discounted_cash":123.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM TETRADECYL SULFATE 3 % (30 MG/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"24201-0201-05","type":"NDC"}],"standard_charges":[{"gross_charge":247.84,"discounted_cash":123.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE (BULK) MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"38779-0009-04","type":"NDC"}],"standard_charges":[{"gross_charge":245.39,"discounted_cash":122.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE  6 MG/24 HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49502-0900-01","type":"NDC"}],"standard_charges":[{"gross_charge":253.15,"discounted_cash":126.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE  6 MG/24 HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"49502-0900-30","type":"NDC"}],"standard_charges":[{"gross_charge":253.15,"discounted_cash":126.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE 12 MG/24 HR TD PT24","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49502-0902-01","type":"NDC"}],"standard_charges":[{"gross_charge":253.15,"discounted_cash":126.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELEGILINE 12 MG/24 HR TD PT24","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"49502-0902-30","type":"NDC"}],"standard_charges":[{"gross_charge":253.15,"discounted_cash":126.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SILDENAFIL (PULM.HYPERTENSION) 10 MG/ML ORAL SUSR","drug_information":{"unit":"112","type":"ML"},"code_information":[{"code":"69238-1574-01","type":"NDC"}],"standard_charges":[{"gross_charge":243.02,"discounted_cash":121.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 1 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"09999-9999-83","type":"NDC"}],"standard_charges":[{"gross_charge":251.41,"discounted_cash":125.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CODEINE PHOSPHATE (BULK) 100 % MISC POWD","drug_information":{"unit":"10","type":"GR"},"code_information":[{"code":"J0745","type":"HCPCS"},{"code":"00406-1548-32","type":"NDC"}],"standard_charges":[{"gross_charge":249.4,"discounted_cash":124.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARGATROBAN 100 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J0883","type":"HCPCS"},{"code":"00143-9674-01","type":"NDC"}],"standard_charges":[{"gross_charge":247.84,"discounted_cash":123.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL IN NACL (ISO-OSM) 2,500 MG/250 ML (10 MG/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"44567-0450-01","type":"NDC"}],"standard_charges":[{"gross_charge":253.65,"discounted_cash":126.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ESMOLOL IN NACL (ISO-OSM) 2,500 MG/250 ML (10 MG/ML) IV SOLP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1805","type":"HCPCS"},{"code":"44567-0450-10","type":"NDC"}],"standard_charges":[{"gross_charge":253.65,"discounted_cash":126.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SINCALIDE 5 MCG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2805","type":"HCPCS"},{"code":"63323-0579-01","type":"NDC"}],"standard_charges":[{"gross_charge":244.83,"discounted_cash":122.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SINCALIDE 5 MCG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2805","type":"HCPCS"},{"code":"63323-0579-05","type":"NDC"}],"standard_charges":[{"gross_charge":244.83,"discounted_cash":122.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CISPLATIN 1 MG/ML FOR DESENSITIZATION","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J9060","type":"HCPCS"},{"code":"63323-0103-64","type":"NDC"}],"standard_charges":[{"gross_charge":243.2,"discounted_cash":121.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE 10% IN ULTRASOUND GEL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00000-0001-69","type":"NDC"}],"standard_charges":[{"gross_charge":269.8,"discounted_cash":134.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES 7.7 KCAL/ML ORAL OIL (ANY SIZE)","drug_information":{"unit":"946","type":"ML"},"code_information":[{"code":"00000-0040-28","type":"NDC"}],"standard_charges":[{"gross_charge":269.61,"discounted_cash":134.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE FUROATE 100 MCG/ACTUATION INHL DSDV","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"00173-0874-14","type":"NDC"}],"standard_charges":[{"gross_charge":258.95,"discounted_cash":129.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 2 % TD OINT","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"00281-0326-60","type":"NDC"}],"standard_charges":[{"gross_charge":265.17,"discounted_cash":132.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 125 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00781-6022-46","type":"NDC"}],"standard_charges":[{"gross_charge":266.76,"discounted_cash":133.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN (BULK) 100 % MISC LIQD","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"03877-9061-31","type":"NDC"}],"standard_charges":[{"gross_charge":258.4,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLYCERIN 100% - SMOG RECTAL ENEMA","drug_information":{"unit":"4000","type":"ML"},"code_information":[{"code":"03877-9061-31","type":"NDC"}],"standard_charges":[{"gross_charge":258.4,"discounted_cash":129.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEDIUM CHAIN TRIGLYCERIDES 7.7 KCAL/ML ORAL OIL","drug_information":{"unit":"946","type":"ML"},"code_information":[{"code":"04167-9365-13","type":"NDC"}],"standard_charges":[{"gross_charge":269.61,"discounted_cash":134.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ULTRA TAG KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-81","type":"NDC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETHANECHOL 1 MG/ML SOLUTION (ANY SIZE)","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"09999-9970-81","type":"NDC"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUORESCEIN 500 MG/5 ML (10 %) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"17478-0253-10","type":"NDC"}],"standard_charges":[{"gross_charge":254.93,"discounted_cash":127.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-1 MG/ML-UNIT/ML-% OTIC DRPS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"24208-0635-62","type":"NDC"}],"standard_charges":[{"gross_charge":259.85,"discounted_cash":129.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOLUTEGRAVIR 50 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"49702-0228-13","type":"NDC"}],"standard_charges":[{"gross_charge":275.94,"discounted_cash":137.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM PHOSPHATE M-/D-BASIC 3 MMOL/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"65219-0056-29","type":"NDC"}],"standard_charges":[{"gross_charge":280.44,"discounted_cash":140.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 50 MCG/ML (1 ML) IT SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0476","type":"HCPCS"},{"code":"66794-0151-01","type":"NDC"}],"standard_charges":[{"gross_charge":279.08,"discounted_cash":139.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXRAZOXANE HCL 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1190","type":"HCPCS"},{"code":"72266-0235-01","type":"NDC"}],"standard_charges":[{"gross_charge":256.54,"discounted_cash":128.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERTAPENEM 20 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1335","type":"HCPCS"},{"code":"09999-9999-64","type":"NDC"}],"standard_charges":[{"gross_charge":268.09,"discounted_cash":134.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 500 MG/4 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0016-12","type":"NDC"}],"standard_charges":[{"gross_charge":279.91,"discounted_cash":139.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2790","type":"HCPCS"},{"code":"13533-0631-03","type":"NDC"}],"standard_charges":[{"gross_charge":280.22,"discounted_cash":140.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2790","type":"HCPCS"},{"code":"13533-0631-11","type":"NDC"}],"standard_charges":[{"gross_charge":280.22,"discounted_cash":140.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN 1,500 UNIT (300 MCG) IM SYRG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2790","type":"HCPCS"},{"code":"13533-0631-20","type":"NDC"}],"standard_charges":[{"gross_charge":280.22,"discounted_cash":140.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STREPTOMYCIN 1 G IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3000","type":"HCPCS"},{"code":"39822-0706-02","type":"NDC"}],"standard_charges":[{"gross_charge":265.54,"discounted_cash":132.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00270-1316-37","type":"NDC"}],"standard_charges":[{"gross_charge":256.2,"discounted_cash":128.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOHEXOL 350 MG IODINE/ML IV SOLN 500 ML *MULTI-DOSE* BTL","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00407-1414-72","type":"NDC"}],"standard_charges":[{"gross_charge":274.0,"discounted_cash":137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GABAPENTIN (BULK) 100 % MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"38779-2461-04","type":"NDC"}],"standard_charges":[{"gross_charge":294.12,"discounted_cash":147.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERCULIN PPD 5 TUB. UNIT /0.1 ML IDRM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"42023-0104-01","type":"NDC"}],"standard_charges":[{"gross_charge":310.39,"discounted_cash":155.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAFENIDE ACETATE 50 G TOP PACK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"49884-0902-52","type":"NDC"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":147.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAFENIDE ACETATE 50 G TOP PACK","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"49884-0902-78","type":"NDC"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":147.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAFENIDE ACETATE 50 G TOP PACK","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"50742-0310-25","type":"NDC"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":147.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAFENIDE ACETATE 50 G TOP PACK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50742-0310-50","type":"NDC"}],"standard_charges":[{"gross_charge":294.58,"discounted_cash":147.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIPOTRIENE 0.005 % TOP CREA","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"68462-0501-65","type":"NDC"}],"standard_charges":[{"gross_charge":297.09,"discounted_cash":148.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"72485-0625-13","type":"NDC"}],"standard_charges":[{"gross_charge":318.04,"discounted_cash":159.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90707","type":"HCPCS"},{"code":"00006-4681-00","type":"NDC"}],"standard_charges":[{"gross_charge":312.09,"discounted_cash":156.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEASLES,MUMPS,RUBELLA VACC(PF) 1,000-12,500 TCID50/0.5 ML SUBQ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90707","type":"HCPCS"},{"code":"00006-4681-01","type":"NDC"}],"standard_charges":[{"gross_charge":312.09,"discounted_cash":156.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP OF TC-99M-SOD PYROPH 12 MG IV SOLR","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"A9538","type":"HCPCS"},{"code":"45567-0060-01","type":"NDC"}],"standard_charges":[{"gross_charge":294.43,"discounted_cash":147.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J0612","type":"HCPCS"},{"code":"63323-0360-61","type":"NDC"}],"standard_charges":[{"gross_charge":281.96,"discounted_cash":140.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  3000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0303-00","type":"NDC"}],"standard_charges":[{"gross_charge":291.08,"discounted_cash":145.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA  3000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0303-01","type":"NDC"}],"standard_charges":[{"gross_charge":291.08,"discounted_cash":145.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1569","type":"HCPCS"},{"code":"00944-2700-02","type":"NDC"}],"standard_charges":[{"gross_charge":299.14,"discounted_cash":149.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUTILIDE FUMARATE 0.1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1742","type":"HCPCS"},{"code":"00009-3794-01","type":"NDC"}],"standard_charges":[{"gross_charge":316.58,"discounted_cash":158.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HETASTARCH IN LACT ELECTROLYTE 6 % IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-1555-54","type":"NDC"}],"standard_charges":[{"gross_charge":288.8,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HETASTARCH IN LACT ELECTROLYTE 6 % IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"00409-1555-64","type":"NDC"}],"standard_charges":[{"gross_charge":288.8,"discounted_cash":144.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROPRUSSIDE 50 MG/250 ML IN D5W (200 MCG/ML) INFUSION KIT","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J7060","type":"HCPCS"},{"code":"00000-0000-89","type":"NDC"}],"standard_charges":[{"gross_charge":297.35,"discounted_cash":148.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARICITINIB (EUA) 2 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00002-4182-30","type":"NDC"}],"standard_charges":[{"gross_charge":318.52,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARICITINIB 2 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00002-4182-30","type":"NDC"}],"standard_charges":[{"gross_charge":318.52,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARICITINIB (EUA) 1 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00002-4732-30","type":"NDC"}],"standard_charges":[{"gross_charge":318.52,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BARICITINIB 1 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00002-4732-30","type":"NDC"}],"standard_charges":[{"gross_charge":318.52,"discounted_cash":159.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT  80 MG ORAL CAP","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"13668-0592-84","type":"NDC"}],"standard_charges":[{"gross_charge":313.28,"discounted_cash":156.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLADRIBINE 10 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"42658-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":311.41,"discounted_cash":155.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 20 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"16729-0114-11","type":"NDC"}],"standard_charges":[{"gross_charge":314.26,"discounted_cash":157.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE 20 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"63323-0104-50","type":"NDC"}],"standard_charges":[{"gross_charge":314.26,"discounted_cash":157.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXALIPLATIN HIPEC SYRINGE","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9263","type":"HCPCS"},{"code":"67457-0442-20","type":"NDC"}],"standard_charges":[{"gross_charge":281.96,"discounted_cash":140.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUGAMMADEX 100 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00006-5423-02","type":"NDC"}],"standard_charges":[{"gross_charge":336.34,"discounted_cash":168.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUGAMMADEX 100 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"00006-5423-12","type":"NDC"}],"standard_charges":[{"gross_charge":336.34,"discounted_cash":168.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE-PRAMOXINE 1-1 % TOP FOAM","drug_information":{"unit":"10","type":"GR"},"code_information":[{"code":"00037-6824-10","type":"NDC"}],"standard_charges":[{"gross_charge":337.6,"discounted_cash":168.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECHOTHIOPHATE IODIDE 0.125 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00046-1065-05","type":"NDC"}],"standard_charges":[{"gross_charge":338.62,"discounted_cash":169.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUTICASONE FUROATE 200 MCG/ACTUATION INHL DSDV","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"00173-0876-14","type":"NDC"}],"standard_charges":[{"gross_charge":346.64,"discounted_cash":173.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE-TIMOLOL 0.2-0.5 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00832-1425-05","type":"NDC"}],"standard_charges":[{"gross_charge":321.9,"discounted_cash":160.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUGAMMADEX 100 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"09999-9997-17","type":"NDC"}],"standard_charges":[{"gross_charge":336.34,"discounted_cash":168.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE-ACETIC ACID 1-2 % OTIC DROP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"51672-3007-01","type":"NDC"}],"standard_charges":[{"gross_charge":349.34,"discounted_cash":174.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYSTEINE (L-CYSTEINE) 50 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"51754-1007-01","type":"NDC"}],"standard_charges":[{"gross_charge":323.69,"discounted_cash":161.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYSTEINE (L-CYSTEINE) 50 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"51754-1007-03","type":"NDC"}],"standard_charges":[{"gross_charge":323.69,"discounted_cash":161.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METRONIDAZOLE 1 % TOP GEL","drug_information":{"unit":"60","type":"GR"},"code_information":[{"code":"66993-0936-61","type":"NDC"}],"standard_charges":[{"gross_charge":329.69,"discounted_cash":164.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LACOSAMIDE 10 MG/ML SYRINGE - PEDS/NICU","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"C9254","type":"HCPCS"},{"code":"00131-1810-67","type":"NDC"}],"standard_charges":[{"gross_charge":342.23,"discounted_cash":171.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLONIDINE HCL (BULK) MISC POWD","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"J0735","type":"HCPCS"},{"code":"51552-0480-02","type":"NDC"}],"standard_charges":[{"gross_charge":321.48,"discounted_cash":160.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DECITABINE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"55111-0556-10","type":"NDC"}],"standard_charges":[{"gross_charge":318.67,"discounted_cash":159.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DECITABINE IV SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0894","type":"HCPCS"},{"code":"55111-0556-10","type":"NDC"}],"standard_charges":[{"gross_charge":318.67,"discounted_cash":159.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBANDRONATE 3 MG/3 ML IV SYRG","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1740","type":"HCPCS"},{"code":"67457-0524-33","type":"NDC"}],"standard_charges":[{"gross_charge":336.38,"discounted_cash":168.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHOHEXITAL 500 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"42023-0105-01","type":"NDC"}],"standard_charges":[{"gross_charge":326.08,"discounted_cash":163.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IFOSFAMIDE 3 GRAM/60 ML IV SOLN","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"J9208","type":"HCPCS"},{"code":"00143-9530-01","type":"NDC"}],"standard_charges":[{"gross_charge":335.85,"discounted_cash":167.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOXANTRONE 2 MG/ML IV CONC","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"63323-0132-10","type":"NDC"}],"standard_charges":[{"gross_charge":320.0,"discounted_cash":160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALBUMIN SYRINGE 25% - NICU","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"P9047","type":"HCPCS"},{"code":"00944-0493-02","type":"NDC"}],"standard_charges":[{"gross_charge":329.46,"discounted_cash":164.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1308-01","type":"NDC"}],"standard_charges":[{"gross_charge":349.97,"discounted_cash":174.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1308-10","type":"NDC"}],"standard_charges":[{"gross_charge":349.97,"discounted_cash":174.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 10000 UNIT/0.25 ML SYRINGE CMP","drug_information":{"unit":"0.25","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"09999-9997-25","type":"NDC"}],"standard_charges":[{"gross_charge":349.97,"discounted_cash":174.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00270-1316-45","type":"NDC"}],"standard_charges":[{"gross_charge":341.6,"discounted_cash":170.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERCULIN PPD 5 TB UNIT/0.1 ML - CPU","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"09999-9997-47","type":"NDC"}],"standard_charges":[{"gross_charge":357.66,"discounted_cash":178.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TUBERCULIN PPD 5 TB UNIT/0.1 ML - NON UNIT DOSE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"09999-9997-47","type":"NDC"}],"standard_charges":[{"gross_charge":357.66,"discounted_cash":178.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOB G (IGG)-GLYCINE 15-18 % RANGE IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"13533-0335-04","type":"NDC"}],"standard_charges":[{"gross_charge":359.83,"discounted_cash":179.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOB G (IGG)-GLYCINE 15-18 % RANGE IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"13533-0335-40","type":"NDC"}],"standard_charges":[{"gross_charge":359.83,"discounted_cash":179.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 0.5 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"17478-0106-10","type":"NDC"}],"standard_charges":[{"gross_charge":357.98,"discounted_cash":178.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CROMOLYN (BULK) MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"38779-0301-04","type":"NDC"}],"standard_charges":[{"gross_charge":359.1,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (BULK) 100 % MISC POWD","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"38779-0731-06","type":"NDC"}],"standard_charges":[{"gross_charge":359.1,"discounted_cash":179.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL (BULK) 100 % MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"51552-0106-05","type":"NDC"}],"standard_charges":[{"gross_charge":365.94,"discounted_cash":182.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, ADULT NO.4 WITH VIT K 3,300 UNIT- 150 MCG/10 ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"54643-5650-02","type":"NDC"}],"standard_charges":[{"gross_charge":359.48,"discounted_cash":179.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A AND B VACCINE (PF) 720 ELISA UNIT- 20 MCG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90636","type":"HCPCS"},{"code":"58160-0815-43","type":"NDC"}],"standard_charges":[{"gross_charge":353.46,"discounted_cash":176.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS A AND B VACCINE (PF) 720 ELISA UNIT- 20 MCG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90636","type":"HCPCS"},{"code":"58160-0815-52","type":"NDC"}],"standard_charges":[{"gross_charge":353.46,"discounted_cash":176.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90734","type":"HCPCS"},{"code":"58160-0955-09","type":"NDC"}],"standard_charges":[{"gross_charge":361.07,"discounted_cash":180.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M SULFER COLLOID FILTERED","drug_information":{"unit":"0.25","type":"UN"},"code_information":[{"code":"A9541","type":"HCPCS"},{"code":"09999-9955-77","type":"NDC"}],"standard_charges":[{"gross_charge":363.0,"discounted_cash":181.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 4 MG/ML WET POWDER VIAL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"00469-3051-30","type":"NDC"}],"standard_charges":[{"gross_charge":365.91,"discounted_cash":182.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMPHOTERICIN B LIPOSOME 50 MG IV SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0289","type":"HCPCS"},{"code":"00469-3051-30","type":"NDC"}],"standard_charges":[{"gross_charge":365.91,"discounted_cash":182.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUPIVACAINE (BULK) 100 % MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"J0665","type":"HCPCS"},{"code":"38779-0524-04","type":"NDC"}],"standard_charges":[{"gross_charge":352.8,"discounted_cash":176.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 20 MCG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"09999-9999-67","type":"NDC"}],"standard_charges":[{"gross_charge":359.8,"discounted_cash":179.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRON SUCROSE 300 MG/265 ML IVPB - CMP","drug_information":{"unit":"265","type":"ML"},"code_information":[{"code":"J1756","type":"HCPCS"},{"code":"09999-9997-27","type":"NDC"}],"standard_charges":[{"gross_charge":355.24,"discounted_cash":177.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUPHENAZINE HCL 2.5 MG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2679","type":"HCPCS"},{"code":"63323-0281-10","type":"NDC"}],"standard_charges":[{"gross_charge":357.7,"discounted_cash":178.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE SODIUM SUCC 2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"00009-0850-01","type":"NDC"}],"standard_charges":[{"gross_charge":363.4,"discounted_cash":181.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLADRIBINE 10MG/10 ML IV SOLN - UNITS IN MCG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9065","type":"HCPCS"},{"code":"63323-0140-10","type":"NDC"}],"standard_charges":[{"gross_charge":352.21,"discounted_cash":176.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDARABINE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9185","type":"HCPCS"},{"code":"24201-0237-01","type":"NDC"}],"standard_charges":[{"gross_charge":358.05,"discounted_cash":179.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDARUBICIN SYRINGE","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9211","type":"HCPCS"},{"code":"00013-2586-91","type":"NDC"}],"standard_charges":[{"gross_charge":353.06,"discounted_cash":176.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 40 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9280","type":"HCPCS"},{"code":"00143-9280-01","type":"NDC"}],"standard_charges":[{"gross_charge":351.54,"discounted_cash":175.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN ABSORBABLE MM POWD","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"00000-0001-79","type":"NDC"}],"standard_charges":[{"gross_charge":371.71,"discounted_cash":185.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDOCAINE HCL 4% WITH ATOMIZER","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00000-0009-50","type":"NDC"}],"standard_charges":[{"gross_charge":376.2,"discounted_cash":188.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00000-0040-10","type":"NDC"}],"standard_charges":[{"gross_charge":373.63,"discounted_cash":186.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECLIPSE C-SERIES HOMEPUMP 270 ML 5.5 DAY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-84","type":"NDC"}],"standard_charges":[{"gross_charge":376.43,"discounted_cash":188.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NYSTATIN 100000 UNITS/ML ORAL SUSP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00121-1045-16","type":"NDC"}],"standard_charges":[{"gross_charge":372.07,"discounted_cash":186.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00469-0520-01","type":"NDC"}],"standard_charges":[{"gross_charge":366.34,"discounted_cash":183.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISAVUCONAZONIUM SULFATE 186 MG ORAL CAP","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"00469-0520-02","type":"NDC"}],"standard_charges":[{"gross_charge":366.34,"discounted_cash":183.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALVIMOPAN 12 MG ORAL CAP","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00591-2312-15","type":"NDC"}],"standard_charges":[{"gross_charge":374.36,"discounted_cash":187.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAXIMIN (XIFAXIN) 20 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"55","type":"ML"},"code_information":[{"code":"09999-9997-53","type":"NDC"}],"standard_charges":[{"gross_charge":373.65,"discounted_cash":186.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXCARBAZEPINE 300 MG/5 ML (60 MG/ML) ORAL SUSP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"42806-0600-22","type":"NDC"}],"standard_charges":[{"gross_charge":373.63,"discounted_cash":186.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM,POTASSIUM,MAG SULFATES 17.5-3.13-1.6 GRAM ORAL SOLR","drug_information":{"unit":"354","type":"ML"},"code_information":[{"code":"52268-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":376.66,"discounted_cash":188.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM NITRITE 30 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"60267-0311-10","type":"NDC"}],"standard_charges":[{"gross_charge":368.6,"discounted_cash":184.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90732","type":"HCPCS"},{"code":"00006-4837-01","type":"NDC"}],"standard_charges":[{"gross_charge":370.35,"discounted_cash":185.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOCOCCAL 23-VAL PS VACCINE 25 MCG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90732","type":"HCPCS"},{"code":"00006-4837-03","type":"NDC"}],"standard_charges":[{"gross_charge":370.35,"discounted_cash":185.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENIN C,Y,W-135 VAC,1 OF 2(PF) 5 MCG X 3/ 0.5 ML (FINAL) IM SOLR","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90734","type":"HCPCS"},{"code":"58160-0959-01","type":"NDC"}],"standard_charges":[{"gross_charge":374.22,"discounted_cash":187.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM THIOSULFATE 12.5 GRAM/50 ML (250 MG/ML) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0209","type":"HCPCS"},{"code":"60267-0705-50","type":"NDC"}],"standard_charges":[{"gross_charge":368.6,"discounted_cash":184.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHORIONIC GONADOTROPIN, HUMAN 10000 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0725","type":"HCPCS"},{"code":"00052-0315-10","type":"NDC"}],"standard_charges":[{"gross_charge":380.98,"discounted_cash":190.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPERIDINE  50 MG/ML INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J2175","type":"HCPCS"},{"code":"00409-1181-30","type":"NDC"}],"standard_charges":[{"gross_charge":380.31,"discounted_cash":190.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (VISCOSUP) 10 MG/ML(MW 2.4 -3.6 MILLION) IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7323","type":"HCPCS"},{"code":"05556-6410-00","type":"NDC"}],"standard_charges":[{"gross_charge":371.53,"discounted_cash":185.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (VISCOSUP) 10 MG/ML(MW 2.4 -3.6 MILLION) IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7323","type":"HCPCS"},{"code":"05556-6410-01","type":"NDC"}],"standard_charges":[{"gross_charge":371.53,"discounted_cash":185.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"81298-8112-01","type":"NDC"}],"standard_charges":[{"gross_charge":368.22,"discounted_cash":184.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOCETAXEL 80 MG/4 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9171","type":"HCPCS"},{"code":"00409-0367-01","type":"NDC"}],"standard_charges":[{"gross_charge":378.56,"discounted_cash":189.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOXANTRONE 2 MG/ML IV CONC","drug_information":{"unit":"12.5","type":"ML"},"code_information":[{"code":"J9293","type":"HCPCS"},{"code":"63323-0132-12","type":"NDC"}],"standard_charges":[{"gross_charge":368.42,"discounted_cash":184.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLR (ANY SIZE)","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"00000-0067-57","type":"NDC"}],"standard_charges":[{"gross_charge":388.5,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOSI-FUSER 250 ML 1-DAY ELASTOMERIC PUMP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-82","type":"NDC"}],"standard_charges":[{"gross_charge":391.67,"discounted_cash":195.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECLIPSE C-SERIES HOMEPUMP 270 ML 1 DAY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-86","type":"NDC"}],"standard_charges":[{"gross_charge":391.67,"discounted_cash":195.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PARENTERAL AMINO ACID 20% NO.1 IV SOLP","drug_information":{"unit":"2000","type":"ML"},"code_information":[{"code":"00338-0499-06","type":"NDC"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RADIOPAQUE PVC MARKERS-BARIUM 24 MARKERS ORAL CAP","drug_information":{"unit":"10","type":"UN"},"code_information":[{"code":"01085-8081-07","type":"NDC"}],"standard_charges":[{"gross_charge":384.62,"discounted_cash":192.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RADIOPAQUE PVC MARKERS-BARIUM 24 MARKERS ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"01085-8081-10","type":"NDC"}],"standard_charges":[{"gross_charge":384.62,"discounted_cash":192.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESFLURANE 100 % INHL LIQD","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"10019-0641-34","type":"NDC"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITROGLYCERIN 400 MCG/SPRAY TL SPRY","drug_information":{"unit":"4.9","type":"GR"},"code_information":[{"code":"45802-0210-01","type":"NDC"}],"standard_charges":[{"gross_charge":392.07,"discounted_cash":196.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIDAXOMICIN 200 MG ORAL TAB","drug_information":{"unit":"20","type":"UN"},"code_information":[{"code":"52015-0080-01","type":"NDC"}],"standard_charges":[{"gross_charge":397.94,"discounted_cash":198.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VANCOMYCIN 25 MG/ML ORAL SOLR","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"52536-0107-10","type":"NDC"}],"standard_charges":[{"gross_charge":388.5,"discounted_cash":194.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EMTRICITA-RILPIVIRINE-TENOF DF 200-25-300 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"61958-1101-01","type":"NDC"}],"standard_charges":[{"gross_charge":407.92,"discounted_cash":203.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NITAZOXANIDE 500 MG ORAL TAB","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"64980-0526-60","type":"NDC"}],"standard_charges":[{"gross_charge":397.5,"discounted_cash":198.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEVIRAPINE 50 MG/5 ML ORAL SUSP","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"65862-0057-24","type":"NDC"}],"standard_charges":[{"gross_charge":415.8,"discounted_cash":207.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE (PF) 10 MG/ML INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1171","type":"HCPCS"},{"code":"00409-2634-50","type":"NDC"}],"standard_charges":[{"gross_charge":399.35,"discounted_cash":199.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 1 GRAM/10 ML (10 %) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-12","type":"NDC"}],"standard_charges":[{"gross_charge":390.32,"discounted_cash":195.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 1 GRAM/10 ML (10 %) INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-13","type":"NDC"}],"standard_charges":[{"gross_charge":390.32,"discounted_cash":195.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON 1 MG/ML INJ SOLR FOR GLUCOMMANDER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0593-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON 1 MG/ML INJ SOLR S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0593-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON HCL 1 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0593-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON 1 MG/ML INJ SOLR FOR GLUCOMMANDER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0596-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON 1 MG/ML INJ SOLR S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0596-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCAGON HCL 1 MG/ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1611","type":"HCPCS"},{"code":"63323-0596-03","type":"NDC"}],"standard_charges":[{"gross_charge":402.29,"discounted_cash":201.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"00172-7313-20","type":"NDC"}],"standard_charges":[{"gross_charge":403.9,"discounted_cash":201.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J7502","type":"HCPCS"},{"code":"09999-9997-51","type":"NDC"}],"standard_charges":[{"gross_charge":403.9,"discounted_cash":201.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLN","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00000-0101-58","type":"NDC"}],"standard_charges":[{"gross_charge":407.82,"discounted_cash":203.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 200 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9073","type":"HCPCS"},{"code":"55150-0271-99","type":"NDC"}],"standard_charges":[{"gross_charge":387.07,"discounted_cash":193.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN, PEG-LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q2050","type":"HCPCS"},{"code":"70710-1530-01","type":"NDC"}],"standard_charges":[{"gross_charge":383.5,"discounted_cash":191.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM-AYOW 300 MCG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"Q5125","type":"HCPCS"},{"code":"70121-1568-01","type":"NDC"}],"standard_charges":[{"gross_charge":387.24,"discounted_cash":193.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 250 MG/5 ML ORAL SUMC (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0041-25","type":"NDC"}],"standard_charges":[{"gross_charge":425.25,"discounted_cash":212.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 250 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0098-28","type":"NDC"}],"standard_charges":[{"gross_charge":447.3,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLARITHROMYCIN 250 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00781-6023-46","type":"NDC"}],"standard_charges":[{"gross_charge":447.3,"discounted_cash":223.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORNASE ALFA 1 MG/ML INHL SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"50242-0100-39","type":"NDC"}],"standard_charges":[{"gross_charge":438.67,"discounted_cash":219.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DORNASE ALFA 1 MG/ML INHL SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"50242-0100-40","type":"NDC"}],"standard_charges":[{"gross_charge":438.67,"discounted_cash":219.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 250 MG/5 ML ORAL SUMC","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"50419-0777-01","type":"NDC"}],"standard_charges":[{"gross_charge":425.25,"discounted_cash":212.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIMONIDINE 0.15 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"61314-0144-05","type":"NDC"}],"standard_charges":[{"gross_charge":468.55,"discounted_cash":234.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10,000-10 MG-UNIT-MG/ML OPHT DRPS","drug_information":{"unit":"7.5","type":"ML"},"code_information":[{"code":"61314-0641-75","type":"NDC"}],"standard_charges":[{"gross_charge":457.36,"discounted_cash":228.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90691","type":"HCPCS"},{"code":"49281-0790-51","type":"NDC"}],"standard_charges":[{"gross_charge":455.18,"discounted_cash":227.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TYPHOID VI POLYSACCH VACCINE 25 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90691","type":"HCPCS"},{"code":"49281-0790-88","type":"NDC"}],"standard_charges":[{"gross_charge":455.18,"discounted_cash":227.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VACC-CPG 1018 (PF) 20 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90739","type":"HCPCS"},{"code":"43528-0003-01","type":"NDC"}],"standard_charges":[{"gross_charge":426.28,"discounted_cash":213.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B VACC-CPG 1018 (PF) 20 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90739","type":"HCPCS"},{"code":"43528-0003-05","type":"NDC"}],"standard_charges":[{"gross_charge":426.28,"discounted_cash":213.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUDEOXYGLUCOSE F-18 20 MCI TO 500 MCI/ML IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9552","type":"HCPCS"},{"code":"65857-0150-30","type":"NDC"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPROSTADIL 500 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0270","type":"HCPCS"},{"code":"00009-3169-06","type":"NDC"}],"standard_charges":[{"gross_charge":422.6,"discounted_cash":211.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIHYDROERGOTAMINE 1 MG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1110","type":"HCPCS"},{"code":"00574-0850-05","type":"NDC"}],"standard_charges":[{"gross_charge":428.33,"discounted_cash":214.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN 100 MCG/ML (0.1 MG/ML) INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1160","type":"HCPCS"},{"code":"70515-0262-10","type":"NDC"}],"standard_charges":[{"gross_charge":449.14,"discounted_cash":224.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF) 10 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"60977-0114-01","type":"NDC"}],"standard_charges":[{"gross_charge":420.07,"discounted_cash":210.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TIROFIBAN-0.9% SODIUM CHLORIDE 12.5 MG/250 ML (50 MCG/ML) IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J3246","type":"HCPCS"},{"code":"25208-0002-02","type":"NDC"}],"standard_charges":[{"gross_charge":424.38,"discounted_cash":212.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHACHOLINE CHLORIDE 0 TO 48 MG/3 ML INHL NEBU","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"J7674","type":"HCPCS"},{"code":"64281-0110-05","type":"NDC"}],"standard_charges":[{"gross_charge":448.25,"discounted_cash":224.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHACHOLINE CHLORIDE 0 TO 48 MG/3 ML INHL NEBU","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"J7674","type":"HCPCS"},{"code":"64281-0110-06","type":"NDC"}],"standard_charges":[{"gross_charge":448.25,"discounted_cash":224.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN SYRINGE FOR HIPEC","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00143-9087-01","type":"NDC"}],"standard_charges":[{"gross_charge":456.4,"discounted_cash":228.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CLOFARABINE 1 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9027","type":"HCPCS"},{"code":"71288-0128-20","type":"NDC"}],"standard_charges":[{"gross_charge":449.61,"discounted_cash":224.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETOPOSIDE PHOSPHATE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9181","type":"HCPCS"},{"code":"00015-3404-20","type":"NDC"}],"standard_charges":[{"gross_charge":463.12,"discounted_cash":231.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM-SNDZ 300 MCG/0.5 ML INJ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"Q5101","type":"HCPCS"},{"code":"61314-0318-10","type":"NDC"}],"standard_charges":[{"gross_charge":423.48,"discounted_cash":211.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CITRATE 8 MEQ/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0039-79","type":"NDC"}],"standard_charges":[{"gross_charge":488.25,"discounted_cash":244.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"00000-0040-47","type":"NDC"}],"standard_charges":[{"gross_charge":488.78,"discounted_cash":244.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0094-02","type":"NDC"}],"standard_charges":[{"gross_charge":486.72,"discounted_cash":243.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LITHIUM CITRATE 60 MG/ML ORAL SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00054-3527-63","type":"NDC"}],"standard_charges":[{"gross_charge":488.25,"discounted_cash":244.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00517-0375-01","type":"NDC"}],"standard_charges":[{"gross_charge":515.85,"discounted_cash":257.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIGOTINDISULFONATE SODIUM 8 MG/ML (0.8 %) INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00517-0375-05","type":"NDC"}],"standard_charges":[{"gross_charge":515.85,"discounted_cash":257.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ITRACONAZOLE 10 MG/ML ORAL SOLN","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"31722-0006-31","type":"NDC"}],"standard_charges":[{"gross_charge":488.78,"discounted_cash":244.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROMORPHONE 1 MG/ML ORAL LIQD (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"42858-0304-16","type":"NDC"}],"standard_charges":[{"gross_charge":486.72,"discounted_cash":243.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"54288-0147-01","type":"NDC"}],"standard_charges":[{"gross_charge":489.16,"discounted_cash":244.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PIMECROLIMUS 1 % TOP CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"68682-0110-01","type":"NDC"}],"standard_charges":[{"gross_charge":470.3,"discounted_cash":235.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOPROTERENOL HCL 0.2 MG/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"69918-0735-10","type":"NDC"}],"standard_charges":[{"gross_charge":470.6,"discounted_cash":235.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOCYANINE GREEN 25 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70100-0424-01","type":"NDC"}],"standard_charges":[{"gross_charge":517.53,"discounted_cash":258.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOCYANINE GREEN 25 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"70100-0424-02","type":"NDC"}],"standard_charges":[{"gross_charge":517.53,"discounted_cash":258.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SMALLPOX,MPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SUBQ SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90611","type":"HCPCS"},{"code":"50632-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":472.5,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SMALLPOX,MPOX LIVE VACCINE(PF) 0.5X TO 3.95X 10EXP8 UNIT/0.5 SUBQ SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90611","type":"HCPCS"},{"code":"50632-0001-02","type":"NDC"}],"standard_charges":[{"gross_charge":472.5,"discounted_cash":236.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTOLOZANE-TAZOBACTAM 1.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0695","type":"HCPCS"},{"code":"67919-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":517.34,"discounted_cash":258.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCORTISONE SOD SUCC (PF) 1000 MG/8 ML INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1720","type":"HCPCS"},{"code":"00009-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":516.29,"discounted_cash":258.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIFAMPIN 600 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"63323-0351-20","type":"NDC"}],"standard_charges":[{"gross_charge":498.89,"discounted_cash":249.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (VISCOSUP) 30 MG/2 ML IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7324","type":"HCPCS"},{"code":"05967-6360-01","type":"NDC"}],"standard_charges":[{"gross_charge":501.59,"discounted_cash":250.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYLAN G-F 20 16 MG/2 ML IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7325","type":"HCPCS"},{"code":"05846-8009-01","type":"NDC"}],"standard_charges":[{"gross_charge":495.37,"discounted_cash":247.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYLAN G-F 20 16 MG/2 ML IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7325","type":"HCPCS"},{"code":"05846-8009-02","type":"NDC"}],"standard_charges":[{"gross_charge":495.37,"discounted_cash":247.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INTERFERON ALFA-N3 5 MILLION UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9215","type":"HCPCS"},{"code":"54746-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":488.46,"discounted_cash":244.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERUMOXYTOL 510 MG/17 ML (30 MG/ML) IV SOLN","drug_information":{"unit":"17","type":"ML"},"code_information":[{"code":"Q0138","type":"HCPCS"},{"code":"59338-0775-01","type":"NDC"}],"standard_charges":[{"gross_charge":480.05,"discounted_cash":240.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0079-75","type":"NDC"}],"standard_charges":[{"gross_charge":550.2,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG/10 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00000-0102-64","type":"NDC"}],"standard_charges":[{"gross_charge":539.35,"discounted_cash":269.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVOFLOXACIN 250 MG/10 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"00527-1948-66","type":"NDC"}],"standard_charges":[{"gross_charge":539.35,"discounted_cash":269.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETIC ACID (BULK)   5 % MISC LIQD","drug_information":{"unit":"3800","type":"ML"},"code_information":[{"code":"05155-2005-58","type":"NDC"}],"standard_charges":[{"gross_charge":518.7,"discounted_cash":259.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CITRIC ACID (BULK) MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"05155-2015-76","type":"NDC"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PREDNISOLONE ACETATE 0.12 % OPHT DRPS","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"11980-0174-05","type":"NDC"}],"standard_charges":[{"gross_charge":523.08,"discounted_cash":261.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALOXAVIR MARBOXIL 40 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50242-0860-01","type":"NDC"}],"standard_charges":[{"gross_charge":534.52,"discounted_cash":267.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BALOXAVIR MARBOXIL 80 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"50242-0877-01","type":"NDC"}],"standard_charges":[{"gross_charge":534.52,"discounted_cash":267.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MVI, PEDI NO.1 WITH VIT K 80 MG-400 UNIT- 200 MCG/5 ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"54643-5647-00","type":"NDC"}],"standard_charges":[{"gross_charge":520.98,"discounted_cash":260.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE TALC 2 G INPL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"62327-0222-02","type":"NDC"}],"standard_charges":[{"gross_charge":521.5,"discounted_cash":260.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE TALC 2 G INPL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"62327-0222-42","type":"NDC"}],"standard_charges":[{"gross_charge":521.5,"discounted_cash":260.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE TALC 4 G INPL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"62327-0444-04","type":"NDC"}],"standard_charges":[{"gross_charge":521.5,"discounted_cash":260.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE TALC 4 G INPL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"62327-0444-44","type":"NDC"}],"standard_charges":[{"gross_charge":521.5,"discounted_cash":260.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"64950-0343-16","type":"NDC"}],"standard_charges":[{"gross_charge":539.7,"discounted_cash":269.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERYTHROMYCIN ETHYLSUCCINATE 200 MG/5 ML ORAL SUSR","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"75834-0295-01","type":"NDC"}],"standard_charges":[{"gross_charge":550.2,"discounted_cash":275.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90620","type":"HCPCS"},{"code":"58160-0976-02","type":"NDC"}],"standard_charges":[{"gross_charge":548.01,"discounted_cash":274.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90620","type":"HCPCS"},{"code":"58160-0976-20","type":"NDC"}],"standard_charges":[{"gross_charge":548.01,"discounted_cash":274.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90750","type":"HCPCS"},{"code":"58160-0819-12","type":"NDC"}],"standard_charges":[{"gross_charge":551.49,"discounted_cash":275.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARICELLA-ZOSTER GE-AS01B (PF) 50 MCG/0.5 ML IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90750","type":"HCPCS"},{"code":"58160-0823-11","type":"NDC"}],"standard_charges":[{"gross_charge":551.49,"discounted_cash":275.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPINEPHRINE 1 MG/ML INJ SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J0171","type":"HCPCS"},{"code":"42023-0168-01","type":"NDC"}],"standard_charges":[{"gross_charge":521.85,"discounted_cash":260.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLATIRAMER 40 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1595","type":"HCPCS"},{"code":"00378-6961-12","type":"NDC"}],"standard_charges":[{"gross_charge":529.91,"discounted_cash":264.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLATIRAMER 40 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1595","type":"HCPCS"},{"code":"00378-6961-32","type":"NDC"}],"standard_charges":[{"gross_charge":529.91,"discounted_cash":264.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR 1 UNIT/ML 100 ML INFUSION - CMP","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9997-41","type":"NDC"}],"standard_charges":[{"gross_charge":528.5,"discounted_cash":264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR 1 UNIT/ML 100 ML INFUSION - CMP FOR GLUCOMMANDER","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"09999-9997-41","type":"NDC"}],"standard_charges":[{"gross_charge":528.5,"discounted_cash":264.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BCG LIVE 50 MG IVES SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9030","type":"HCPCS"},{"code":"00052-0602-02","type":"NDC"}],"standard_charges":[{"gross_charge":532.53,"discounted_cash":266.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 0.5 MG/ML SUSPENSION 120 ML (ANY SIZE)","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"00000-0002-71","type":"NDC"}],"standard_charges":[{"gross_charge":571.2,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 125 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00000-0039-84","type":"NDC"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (RECOMBINANT) 20000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00338-0328-01","type":"NDC"}],"standard_charges":[{"gross_charge":592.55,"discounted_cash":296.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (RECOMBINANT) 20000 UNITS TOP SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00338-0330-01","type":"NDC"}],"standard_charges":[{"gross_charge":592.55,"discounted_cash":296.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMB,HM-FIBRIN-APROTIN,S-CA  2 ML TOP KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00338-4301-02","type":"NDC"}],"standard_charges":[{"gross_charge":631.05,"discounted_cash":315.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHONDROITIN SULF-SOD HYALURON 4-3 % (40-30 MG/ML) IO SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"08065-1839-05","type":"NDC"}],"standard_charges":[{"gross_charge":621.67,"discounted_cash":310.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 0.5 MG/ML SUSPENSION 120 ML","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9991-71","type":"NDC"}],"standard_charges":[{"gross_charge":571.2,"discounted_cash":285.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 10 MCG/SPRAY (0.1 ML) NASL SPRY","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"24208-0342-05","type":"NDC"}],"standard_charges":[{"gross_charge":575.12,"discounted_cash":287.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LINEZOLID 100 MG/5 ML ORAL SUSR","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"60687-0754-05","type":"NDC"}],"standard_charges":[{"gross_charge":623.18,"discounted_cash":311.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 2.5-108 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"64950-0343-16","type":"NDC"}],"standard_charges":[{"gross_charge":584.4,"discounted_cash":292.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NAPROXEN 125 MG/5 ML ORAL SUSP","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"70954-0151-10","type":"NDC"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBQ SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90716","type":"HCPCS"},{"code":"00006-4827-00","type":"NDC"}],"standard_charges":[{"gross_charge":579.76,"discounted_cash":289.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARICELLA VIRUS VACC LIVE (PF) 1350 UNIT/0.5 ML SUBQ SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90716","type":"HCPCS"},{"code":"00006-4827-01","type":"NDC"}],"standard_charges":[{"gross_charge":579.76,"discounted_cash":289.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VARICELLA-ZOSTER GE VAC,2 OF 2 50 MCG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90750","type":"HCPCS"},{"code":"58160-0828-03","type":"NDC"}],"standard_charges":[{"gross_charge":600.16,"discounted_cash":300.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THALLOUS CHLORIDE TL-201 37 MBQ/ML (1 MCI/ML) IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9505","type":"HCPCS"},{"code":"17156-0299-16","type":"NDC"}],"standard_charges":[{"gross_charge":608.4,"discounted_cash":304.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 10,000 MCG/20ML (500 MCG/ML) IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"66794-0155-02","type":"NDC"}],"standard_charges":[{"gross_charge":589.05,"discounted_cash":294.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 400 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"00456-0400-01","type":"NDC"}],"standard_charges":[{"gross_charge":631.68,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 400 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"00456-0400-10","type":"NDC"}],"standard_charges":[{"gross_charge":631.68,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"00456-0600-01","type":"NDC"}],"standard_charges":[{"gross_charge":631.68,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAROLINE FOSAMIL 600 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0712","type":"HCPCS"},{"code":"00456-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":631.68,"discounted_cash":315.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC CARBOXYMALTOSE 100 MG IRON/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J1439","type":"HCPCS"},{"code":"00517-0602-01","type":"NDC"}],"standard_charges":[{"gross_charge":621.64,"discounted_cash":310.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 2 MG CATH SOLR (MIXTURE INGREDIENT)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"04083-1310-02","type":"NDC"}],"standard_charges":[{"gross_charge":595.63,"discounted_cash":297.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE   2 MG CATH SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"gross_charge":595.63,"discounted_cash":297.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 2 MG INJ SOLR FOR CHARGING","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0041-64","type":"NDC"}],"standard_charges":[{"gross_charge":595.63,"discounted_cash":297.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG ORAL CAP","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00781-2323-06","type":"NDC"}],"standard_charges":[{"gross_charge":592.83,"discounted_cash":296.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG ORAL CAP","drug_information":{"unit":"6","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00781-2323-68","type":"NDC"}],"standard_charges":[{"gross_charge":592.83,"discounted_cash":296.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THIOTEPA  15 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9340","type":"HCPCS"},{"code":"00143-9565-01","type":"NDC"}],"standard_charges":[{"gross_charge":604.42,"discounted_cash":302.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM-AYOW 480 MCG/0.8 ML SUBQ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"Q5125","type":"HCPCS"},{"code":"70121-1570-01","type":"NDC"}],"standard_charges":[{"gross_charge":619.54,"discounted_cash":309.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM CHLORIDE 10 % ORAL LIQD (ANY SIZE)","drug_information":{"unit":"3800","type":"ML"},"code_information":[{"code":"00000-0039-78","type":"NDC"}],"standard_charges":[{"gross_charge":666.9,"discounted_cash":333.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 270 ML DC 4 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-74","type":"NDC"}],"standard_charges":[{"gross_charge":695.37,"discounted_cash":347.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 270 ML SC 5 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-77","type":"NDC"}],"standard_charges":[{"gross_charge":695.37,"discounted_cash":347.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIFLUPREDNATE 0.05 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00065-9240-07","type":"NDC"}],"standard_charges":[{"gross_charge":660.01,"discounted_cash":330.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NEVIRAPINE 50 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"240","type":"ML"},"code_information":[{"code":"00597-0047-00","type":"NDC"}],"standard_charges":[{"gross_charge":639.24,"discounted_cash":319.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN 0.3 MG/ML DILUTION","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-09","type":"NDC"}],"standard_charges":[{"gross_charge":662.97,"discounted_cash":331.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIFEDIPINE (BULK) MISC POWD","drug_information":{"unit":"100","type":"GR"},"code_information":[{"code":"60592-0507-01","type":"NDC"}],"standard_charges":[{"gross_charge":651.0,"discounted_cash":325.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ACETAMINOPHEN-CODEINE 120-12 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"64950-0374-16","type":"NDC"}],"standard_charges":[{"gross_charge":653.93,"discounted_cash":326.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRINZOLAMIDE 1 % OPHT DRPS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"68682-0464-10","type":"NDC"}],"standard_charges":[{"gross_charge":662.87,"discounted_cash":331.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OXYCODONE 5 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"71930-0022-43","type":"NDC"}],"standard_charges":[{"gross_charge":632.41,"discounted_cash":316.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90670","type":"HCPCS"},{"code":"00005-1971-01","type":"NDC"}],"standard_charges":[{"gross_charge":664.97,"discounted_cash":332.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOC 13-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90670","type":"HCPCS"},{"code":"00005-1971-02","type":"NDC"}],"standard_charges":[{"gross_charge":664.97,"discounted_cash":332.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0153","type":"HCPCS"},{"code":"00469-0871-20","type":"NDC"}],"standard_charges":[{"gross_charge":672.82,"discounted_cash":336.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 130 MG/18 ML (7.2 MG/ML) IV EMUL","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"J0185","type":"HCPCS"},{"code":"47426-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":666.2,"discounted_cash":333.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHA-1 PROTEINASE INHIB.(HUM)  500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0256","type":"HCPCS"},{"code":"13533-0601-30","type":"NDC"}],"standard_charges":[{"gross_charge":677.25,"discounted_cash":338.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFIDEROCOL 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0699","type":"HCPCS"},{"code":"59630-0266-01","type":"NDC"}],"standard_charges":[{"gross_charge":665.14,"discounted_cash":332.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFIDEROCOL 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0699","type":"HCPCS"},{"code":"59630-0266-10","type":"NDC"}],"standard_charges":[{"gross_charge":665.14,"discounted_cash":332.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  25 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0002-01","type":"NDC"}],"standard_charges":[{"gross_charge":652.91,"discounted_cash":326.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  25 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0002-04","type":"NDC"}],"standard_charges":[{"gross_charge":652.91,"discounted_cash":326.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSCARNET 24 MG/ML IV SOLN","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1455","type":"HCPCS"},{"code":"23155-0771-31","type":"NDC"}],"standard_charges":[{"gross_charge":645.75,"discounted_cash":322.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN  4 MCG/ML INJ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2597","type":"HCPCS"},{"code":"83634-0451-10","type":"NDC"}],"standard_charges":[{"gross_charge":652.19,"discounted_cash":326.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHYLPREDNISOLONE 10 MG/ML SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"J2919","type":"HCPCS"},{"code":"09999-9999-24","type":"NDC"}],"standard_charges":[{"gross_charge":682.5,"discounted_cash":341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE  90 MCG/ACTUATION INHL AEPB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00186-0917-06","type":"NDC"}],"standard_charges":[{"gross_charge":647.5,"discounted_cash":323.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM-SNDZ 480 MCG/0.8 ML INJ SYRG","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"Q5101","type":"HCPCS"},{"code":"61314-0326-01","type":"NDC"}],"standard_charges":[{"gross_charge":677.57,"discounted_cash":338.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUGAMMADEX 100 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00006-5425-05","type":"NDC"}],"standard_charges":[{"gross_charge":719.15,"discounted_cash":359.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUGAMMADEX 100 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00006-5425-15","type":"NDC"}],"standard_charges":[{"gross_charge":719.15,"discounted_cash":359.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIMATOPROST 0.01 % OPHT DROP","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"00023-3205-03","type":"NDC"}],"standard_charges":[{"gross_charge":760.83,"discounted_cash":380.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELENIUM 60 MCG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00517-6560-01","type":"NDC"}],"standard_charges":[{"gross_charge":695.59,"discounted_cash":347.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SELENIUM 60 MCG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00517-6560-05","type":"NDC"}],"standard_charges":[{"gross_charge":695.59,"discounted_cash":347.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHONDROITIN SULF-SOD HYALURON 3 %-4 %(0.35ML) 1 % (0.4 ML) IO SYRG","drug_information":{"unit":"0.75","type":"ML"},"code_information":[{"code":"08065-1831-35","type":"NDC"}],"standard_charges":[{"gross_charge":758.59,"discounted_cash":379.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"09999-9997-54","type":"NDC"}],"standard_charges":[{"gross_charge":766.65,"discounted_cash":383.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMDESIVIR 100 MG IVPB - CMP","drug_information":{"unit":"120","type":"ML"},"code_information":[{"code":"09999-9998-46","type":"NDC"}],"standard_charges":[{"gross_charge":728.91,"discounted_cash":364.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIAZOXIDE 50 MG/ML ORAL SUSP","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"13517-0100-30","type":"NDC"}],"standard_charges":[{"gross_charge":766.65,"discounted_cash":383.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMBIN (BOVINE) 20000 UNITS TOP SPSY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"60793-0217-22","type":"NDC"}],"standard_charges":[{"gross_charge":768.95,"discounted_cash":384.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90651","type":"HCPCS"},{"code":"00006-4119-01","type":"NDC"}],"standard_charges":[{"gross_charge":743.76,"discounted_cash":371.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90651","type":"HCPCS"},{"code":"00006-4119-03","type":"NDC"}],"standard_charges":[{"gross_charge":743.76,"discounted_cash":371.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90677","type":"HCPCS"},{"code":"00005-2000-01","type":"NDC"}],"standard_charges":[{"gross_charge":708.36,"discounted_cash":354.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PNEUMOC 20-VAL CONJ-DIP CR(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90677","type":"HCPCS"},{"code":"00005-2000-10","type":"NDC"}],"standard_charges":[{"gross_charge":708.36,"discounted_cash":354.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN  500 MCG/ML IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"70121-2501-01","type":"NDC"}],"standard_charges":[{"gross_charge":698.75,"discounted_cash":349.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0558","type":"HCPCS"},{"code":"60793-0600-02","type":"NDC"}],"standard_charges":[{"gross_charge":736.1,"discounted_cash":368.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(600K/600K) IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0558","type":"HCPCS"},{"code":"60793-0600-10","type":"NDC"}],"standard_charges":[{"gross_charge":736.1,"discounted_cash":368.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0558","type":"HCPCS"},{"code":"60793-0602-02","type":"NDC"}],"standard_charges":[{"gross_charge":736.1,"discounted_cash":368.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHIN,PROCAIN 1,200,000 UNIT/ 2 ML(900K/300K) IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0558","type":"HCPCS"},{"code":"60793-0602-10","type":"NDC"}],"standard_charges":[{"gross_charge":736.1,"discounted_cash":368.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BIVALIRUDIN 250 MG/50 ML IN NS (5 MG/ML) INFUSION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0583","type":"HCPCS"},{"code":"00000-0061-72","type":"NDC"}],"standard_charges":[{"gross_charge":700.54,"discounted_cash":350.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM-VABORBACTAM 2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2186","type":"HCPCS"},{"code":"70842-0120-01","type":"NDC"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEROPENEM-VABORBACTAM 2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2186","type":"HCPCS"},{"code":"70842-0120-06","type":"NDC"}],"standard_charges":[{"gross_charge":702.0,"discounted_cash":351.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"72266-0163-01","type":"NDC"}],"standard_charges":[{"gross_charge":758.72,"discounted_cash":379.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN SULFATE 1.2 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3260","type":"HCPCS"},{"code":"72266-0163-06","type":"NDC"}],"standard_charges":[{"gross_charge":758.72,"discounted_cash":379.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL (XYNTHA) S.O.","drug_information":{"unit":"235","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":699.13,"discounted_cash":349.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL 250 (+/-) UNIT IV SOLN","drug_information":{"unit":"235","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":699.13,"discounted_cash":349.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (VISCOSUP) 10 MG/ML IATC SYRG","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J7321","type":"HCPCS"},{"code":"08913-0444-41","type":"NDC"}],"standard_charges":[{"gross_charge":743.96,"discounted_cash":371.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOXORUBICIN  50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9000","type":"HCPCS"},{"code":"00143-9277-01","type":"NDC"}],"standard_charges":[{"gross_charge":756.67,"discounted_cash":378.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOPAMIDOL 76 % IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"Q9967","type":"HCPCS"},{"code":"00270-1316-98","type":"NDC"}],"standard_charges":[{"gross_charge":747.25,"discounted_cash":373.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXMEDETOMIDINE 200 MCG/50 ML IN NS (4 MCG/ML) INFUSION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"00000-0065-78","type":"NDC"}],"standard_charges":[{"gross_charge":854.59,"discounted_cash":427.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BERACTANT IN 0.9 %SOD.CHLORIDE 25 MG/ML INTR SUSP","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00074-1040-04","type":"NDC"}],"standard_charges":[{"gross_charge":811.83,"discounted_cash":405.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN 0.3 % OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"00078-0813-01","type":"NDC"}],"standard_charges":[{"gross_charge":771.49,"discounted_cash":385.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OPHT OINT","drug_information":{"unit":"3.5","type":"GR"},"code_information":[{"code":"00078-0876-01","type":"NDC"}],"standard_charges":[{"gross_charge":821.35,"discounted_cash":410.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELTROMBOPAG OLAMINE 12.5 MG ORAL PWPK","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00078-0972-19","type":"NDC"}],"standard_charges":[{"gross_charge":785.06,"discounted_cash":392.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELTROMBOPAG OLAMINE 12.5 MG ORAL PWPK","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"00078-0972-61","type":"NDC"}],"standard_charges":[{"gross_charge":785.06,"discounted_cash":392.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHONDROITIN SULF-SOD HYALURON 3 %-4 %(0.5 ML) 1 % (0.55 ML) IO SYRG","drug_information":{"unit":"1.05","type":"ML"},"code_information":[{"code":"08065-1831-50","type":"NDC"}],"standard_charges":[{"gross_charge":802.46,"discounted_cash":401.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN LYSINE 4 MG/ML IV SYRINGE - FROM STOCK SOLUTION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"09999-9999-54","type":"NDC"}],"standard_charges":[{"gross_charge":818.09,"discounted_cash":409.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COLLAGENASE CLOSTRIDIUM HISTO. 250 UNIT/GRAM TOP OINT","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"50484-0010-30","type":"NDC"}],"standard_charges":[{"gross_charge":855.47,"discounted_cash":427.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN LYSINE (PF) 20 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66993-0490-36","type":"NDC"}],"standard_charges":[{"gross_charge":811.9,"discounted_cash":405.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IBUPROFEN LYSINE (PF) 20 MG/2 ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"66993-0490-84","type":"NDC"}],"standard_charges":[{"gross_charge":811.9,"discounted_cash":405.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASCORBIC ACID (VITAMIN C) 500 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"67157-0101-50","type":"NDC"}],"standard_charges":[{"gross_charge":819.33,"discounted_cash":409.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIMETHAMINE 25 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"69413-0330-30","type":"NDC"}],"standard_charges":[{"gross_charge":828.75,"discounted_cash":414.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POTASSIUM IODIDE 1 G/ML ORAL SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"75834-0280-30","type":"NDC"}],"standard_charges":[{"gross_charge":853.62,"discounted_cash":426.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90651","type":"HCPCS"},{"code":"00006-4121-01","type":"NDC"}],"standard_charges":[{"gross_charge":844.78,"discounted_cash":422.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90651","type":"HCPCS"},{"code":"00006-4121-02","type":"NDC"}],"standard_charges":[{"gross_charge":844.78,"discounted_cash":422.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GADOXETATE 3.75 MMOL/15 ML IV SOLN 15 ML VIAL","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"A9581","type":"HCPCS"},{"code":"50419-0320-15","type":"NDC"}],"standard_charges":[{"gross_charge":826.62,"discounted_cash":413.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LETERMOVIR 480 MG ORAL TAB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"00006-3076-03","type":"NDC"}],"standard_charges":[{"gross_charge":849.29,"discounted_cash":424.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LETERMOVIR 480 MG ORAL TAB","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"00006-3076-04","type":"NDC"}],"standard_charges":[{"gross_charge":849.29,"discounted_cash":424.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LECANEMAB-IRMB 100 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"62856-0212-01","type":"NDC"}],"standard_charges":[{"gross_charge":828.14,"discounted_cash":414.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BUDESONIDE 180 MCG/ACTUATION INHL AEPB","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00186-0916-12","type":"NDC"}],"standard_charges":[{"gross_charge":803.37,"discounted_cash":401.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS 5 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J7525","type":"HCPCS"},{"code":"00469-3016-01","type":"NDC"}],"standard_charges":[{"gross_charge":776.54,"discounted_cash":388.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NELARABINE 250 MG/50 ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9261","type":"HCPCS"},{"code":"71288-0165-54","type":"NDC"}],"standard_charges":[{"gross_charge":832.65,"discounted_cash":416.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 50 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"00000-0060-00","type":"NDC"}],"standard_charges":[{"gross_charge":871.63,"discounted_cash":435.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECLIPSE C-SERIES HOMEPUMP 270 ML 2 DAY","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-85","type":"NDC"}],"standard_charges":[{"gross_charge":897.36,"discounted_cash":448.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OLOPATADINE 0.1 % OPHT DROP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"00065-0271-05","type":"NDC"}],"standard_charges":[{"gross_charge":886.7,"discounted_cash":443.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMB,HM-FIBRIN-APROTIN,S-CA  4 ML TOP SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"00338-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":920.18,"discounted_cash":460.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DESMOPRESSIN 10 MCG/ML BUCCAL SOLUTION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"09999-9997-38","type":"NDC"}],"standard_charges":[{"gross_charge":892.94,"discounted_cash":446.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISONIAZID 50 MG/5 ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"46287-0009-01","type":"NDC"}],"standard_charges":[{"gross_charge":871.63,"discounted_cash":435.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THALIDOMIDE 100 MG ORAL CAP","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"59572-0210-15","type":"NDC"}],"standard_charges":[{"gross_charge":901.58,"discounted_cash":450.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THALIDOMIDE 150 MG ORAL CAP","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"59572-0215-13","type":"NDC"}],"standard_charges":[{"gross_charge":964.01,"discounted_cash":482.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANDIDA ALBICANS SKIN TEST FDA STANDARD IDRM ALRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"59584-0138-01","type":"NDC"}],"standard_charges":[{"gross_charge":896.32,"discounted_cash":448.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"49281-0250-51","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"49281-0252-51","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"50632-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE S.O.","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"50632-0013-01","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"50632-0013-01","type":"NDC"}],"standard_charges":[{"gross_charge":922.22,"discounted_cash":461.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COCAINE  4 % NASL SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"C9143","type":"HCPCS"},{"code":"70839-0362-04","type":"NDC"}],"standard_charges":[{"gross_charge":890.24,"discounted_cash":445.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0701-02","type":"NDC"}],"standard_charges":[{"gross_charge":923.44,"discounted_cash":461.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYRG (PARTIAL)","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0701-02","type":"NDC"}],"standard_charges":[{"gross_charge":923.44,"discounted_cash":461.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0701-10","type":"NDC"}],"standard_charges":[{"gross_charge":923.44,"discounted_cash":461.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 1200000 UNIT/2 ML IM SYRG (PARTIAL)","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0701-10","type":"NDC"}],"standard_charges":[{"gross_charge":923.44,"discounted_cash":461.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INCOBOTULINUMTOXINA  50 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0588","type":"HCPCS"},{"code":"00259-1605-01","type":"NDC"}],"standard_charges":[{"gross_charge":871.0,"discounted_cash":435.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  40 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0003-01","type":"NDC"}],"standard_charges":[{"gross_charge":970.02,"discounted_cash":485.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  40 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0003-04","type":"NDC"}],"standard_charges":[{"gross_charge":970.02,"discounted_cash":485.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0320-00","type":"NDC"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML PARTIAL DOSE SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0320-00","type":"NDC"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0320-04","type":"NDC"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 20000 UNIT/ML PARTIAL DOSE SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0320-04","type":"NDC"}],"standard_charges":[{"gross_charge":910.0,"discounted_cash":455.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXRAZOXANE HCL 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1190","type":"HCPCS"},{"code":"00143-9248-01","type":"NDC"}],"standard_charges":[{"gross_charge":913.51,"discounted_cash":456.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 2.5 GRAM/25 ML (10 %) INJ SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-15","type":"NDC"}],"standard_charges":[{"gross_charge":906.1,"discounted_cash":453.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 2.5 GRAM/25 ML (10 %) INJ SOLN","drug_information":{"unit":"25","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-16","type":"NDC"}],"standard_charges":[{"gross_charge":906.1,"discounted_cash":453.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUM U-500 CONC 500 UNIT/ML (3 ML) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8824-01","type":"NDC"}],"standard_charges":[{"gross_charge":860.67,"discounted_cash":430.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INSULIN REGULAR HUM U-500 CONC 500 UNIT/ML (3 ML) SUBQ INPN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1815","type":"HCPCS"},{"code":"00002-8824-27","type":"NDC"}],"standard_charges":[{"gross_charge":860.67,"discounted_cash":430.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MORPHINE (PF) 25 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2274","type":"HCPCS"},{"code":"66794-0162-02","type":"NDC"}],"standard_charges":[{"gross_charge":969.8,"discounted_cash":484.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIPROFLOXACIN 6 % (6 MG/0.1 ML) ITYM SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J7342","type":"HCPCS"},{"code":"69251-0201-01","type":"NDC"}],"standard_charges":[{"gross_charge":920.4,"discounted_cash":460.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALGANCICLOVIR 50 MG/ML SOL (ANY SIZE)","drug_information":{"unit":"88","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00591-2579-PH","type":"NDC"}],"standard_charges":[{"gross_charge":932.36,"discounted_cash":466.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VALGANCICLOVIR 50 MG/ML ORAL SOLR","drug_information":{"unit":"88","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"70010-0051-40","type":"NDC"}],"standard_charges":[{"gross_charge":932.36,"discounted_cash":466.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 10 MG/5 ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"00000-0040-79","type":"NDC"}],"standard_charges":[{"gross_charge":1085.5,"discounted_cash":542.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BETAXOLOL 0.25 % OPHT DRPS","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00078-0729-10","type":"NDC"}],"standard_charges":[{"gross_charge":1117.65,"discounted_cash":558.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROMETHAMINE 36 MG/ML (0.3 M) IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00409-1593-04","type":"NDC"}],"standard_charges":[{"gross_charge":981.5,"discounted_cash":490.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TROMETHAMINE 36 MG/ML (0.3 M) IV SOLN","drug_information":{"unit":"500","type":"ML"},"code_information":[{"code":"00409-1593-14","type":"NDC"}],"standard_charges":[{"gross_charge":981.5,"discounted_cash":490.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STERILE PHENOL (PF) 6 % INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"05446-1476-05","type":"NDC"}],"standard_charges":[{"gross_charge":975.0,"discounted_cash":487.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THALIDOMIDE 200 MG ORAL CAP","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"59572-0220-16","type":"NDC"}],"standard_charges":[{"gross_charge":1026.48,"discounted_cash":513.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PAROXETINE HCL 10 MG/5 ML ORAL SUSP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"70954-0319-10","type":"NDC"}],"standard_charges":[{"gross_charge":1085.5,"discounted_cash":542.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M MERTIATIDE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9562","type":"HCPCS"},{"code":"00019-N096-B0","type":"NDC"}],"standard_charges":[{"gross_charge":982.56,"discounted_cash":491.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 20,000 MCG/20ML (1,000 MCG/ML) IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"66794-0156-02","type":"NDC"}],"standard_charges":[{"gross_charge":1093.95,"discounted_cash":546.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIMABOTULINUMTOXINB 2500 UNIT/0.5 ML IM SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J0587","type":"HCPCS"},{"code":"10454-0710-10","type":"NDC"}],"standard_charges":[{"gross_charge":1011.76,"discounted_cash":505.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 25 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1410","type":"HCPCS"},{"code":"00046-0749-05","type":"NDC"}],"standard_charges":[{"gross_charge":1114.49,"discounted_cash":557.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 300 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"55513-0530-01","type":"NDC"}],"standard_charges":[{"gross_charge":986.41,"discounted_cash":493.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 300 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"55513-0530-10","type":"NDC"}],"standard_charges":[{"gross_charge":986.41,"discounted_cash":493.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSCARNET 24 MG/ML IV SOLN PARTIAL VIAL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1455","type":"HCPCS"},{"code":"76310-0024-15","type":"NDC"}],"standard_charges":[{"gross_charge":1029.44,"discounted_cash":514.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOSCARNET 24 MG/ML IV SOLN PARTIAL VIAL","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"J1455","type":"HCPCS"},{"code":"76310-0024-25","type":"NDC"}],"standard_charges":[{"gross_charge":1029.44,"discounted_cash":514.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"72769-0181-01","type":"NDC"}],"standard_charges":[{"gross_charge":1029.15,"discounted_cash":514.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMIVIR (PF) 200 MG/20 ML (10 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2547","type":"HCPCS"},{"code":"72769-0181-03","type":"NDC"}],"standard_charges":[{"gross_charge":1029.15,"discounted_cash":514.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RHO(D) IMMUNE GLOBULIN-MALTOSE 1,500 UNIT (300 MCG)/1.3 ML INJ SOLN","drug_information":{"unit":"1.3","type":"ML"},"code_information":[{"code":"J2792","type":"HCPCS"},{"code":"53270-3300-01","type":"NDC"}],"standard_charges":[{"gross_charge":1093.86,"discounted_cash":546.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH (ADVATE) S.O.","drug_information":{"unit":"250","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3051-02","type":"NDC"}],"standard_charges":[{"gross_charge":1096.88,"discounted_cash":548.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH 250 (+/-) UNIT IV SOLR","drug_information":{"unit":"250","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3051-02","type":"NDC"}],"standard_charges":[{"gross_charge":1096.88,"discounted_cash":548.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SUSR (ANY SIZE)","drug_information":{"unit":"160","type":"ML"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"00000-0095-60","type":"NDC"}],"standard_charges":[{"gross_charge":1109.68,"discounted_cash":554.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML ORAL SUSR","drug_information":{"unit":"160","type":"ML"},"code_information":[{"code":"J7517","type":"HCPCS"},{"code":"69238-1595-02","type":"NDC"}],"standard_charges":[{"gross_charge":1109.68,"discounted_cash":554.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG (25 MG/ ML FINAL CONC.) ORAL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00006-3066-01","type":"NDC"}],"standard_charges":[{"gross_charge":1035.1,"discounted_cash":517.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG (25 MG/ ML FINAL CONC.) ORAL SUSR - PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00006-3066-01","type":"NDC"}],"standard_charges":[{"gross_charge":1035.1,"discounted_cash":517.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG (25 MG/ ML FINAL CONC.) ORAL SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00006-3066-03","type":"NDC"}],"standard_charges":[{"gross_charge":1035.1,"discounted_cash":517.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"APREPITANT 125 MG (25 MG/ ML FINAL CONC.) ORAL SUSR - PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J8501","type":"HCPCS"},{"code":"00006-3066-03","type":"NDC"}],"standard_charges":[{"gross_charge":1035.1,"discounted_cash":517.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DASATINIB  70 MG ORAL TAB","drug_information":{"unit":"60","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00003-0524-11","type":"NDC"}],"standard_charges":[{"gross_charge":1058.36,"discounted_cash":529.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEGARELIX  80 MG SUBQ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9155","type":"HCPCS"},{"code":"55566-8303-01","type":"NDC"}],"standard_charges":[{"gross_charge":1056.81,"discounted_cash":528.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STREPTOZOCIN 1 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9320","type":"HCPCS"},{"code":"00703-4636-01","type":"NDC"}],"standard_charges":[{"gross_charge":992.72,"discounted_cash":496.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID 25 % ORAL SOLN (ANY SIZE)","drug_information":{"unit":"236.5","type":"ML"},"code_information":[{"code":"00000-0039-51","type":"NDC"}],"standard_charges":[{"gross_charge":1235.49,"discounted_cash":617.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE 25 MG/5 ML ORAL SUSP","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"09999-9997-14","type":"NDC"}],"standard_charges":[{"gross_charge":1188.09,"discounted_cash":594.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDOMETHACIN (BULK) MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"09999-9997-18","type":"NDC"}],"standard_charges":[{"gross_charge":1225.25,"discounted_cash":612.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETRACYCLINE HCL (BULK) MISC POWD","drug_information":{"unit":"500","type":"GR"},"code_information":[{"code":"38779-0053-08","type":"NDC"}],"standard_charges":[{"gross_charge":1184.63,"discounted_cash":592.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TACROLIMUS (BULK) 100 % MISC POWD","drug_information":{"unit":"0.25","type":"GR"},"code_information":[{"code":"38779-2698-07","type":"NDC"}],"standard_charges":[{"gross_charge":1126.13,"discounted_cash":563.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPIRONOLACTONE 25 MG/5 ML ORAL SUSP","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"46287-0020-04","type":"NDC"}],"standard_charges":[{"gross_charge":1188.09,"discounted_cash":594.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES VACC,HUMAN DIPLOID (PF) 2.5 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"90675","type":"HCPCS"},{"code":"49281-0252-51","type":"NDC"}],"standard_charges":[{"gross_charge":1261.91,"discounted_cash":630.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"90713","type":"HCPCS"},{"code":"49281-0860-10","type":"NDC"}],"standard_charges":[{"gross_charge":1227.69,"discounted_cash":613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLIOVIRUS VACCINE 40-8-32 UNIT/0.5 ML INJ SUSP","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"90713","type":"HCPCS"},{"code":"49281-0860-78","type":"NDC"}],"standard_charges":[{"gross_charge":1227.69,"discounted_cash":613.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP TC 99M-PENTETIC ACID 20 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9539","type":"HCPCS"},{"code":"65174-0288-30","type":"NDC"}],"standard_charges":[{"gross_charge":1214.82,"discounted_cash":607.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT FOR PREP TC-99M-BICISATE 0.9 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9557","type":"HCPCS"},{"code":"11994-0006-02","type":"NDC"}],"standard_charges":[{"gross_charge":1127.13,"discounted_cash":563.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0714","type":"HCPCS"},{"code":"00456-2700-01","type":"NDC"}],"standard_charges":[{"gross_charge":1197.25,"discounted_cash":598.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEFTAZIDIME-AVIBACTAM 2.5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0714","type":"HCPCS"},{"code":"00456-2700-10","type":"NDC"}],"standard_charges":[{"gross_charge":1197.25,"discounted_cash":598.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CIDOFOVIR 75 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0740","type":"HCPCS"},{"code":"67457-0210-05","type":"NDC"}],"standard_charges":[{"gross_charge":1150.37,"discounted_cash":575.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 1 MG/ML IV SYRINGE - SUPPORTIVE CARE","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1230","type":"HCPCS"},{"code":"09999-9991-02","type":"NDC"}],"standard_charges":[{"gross_charge":1192.1,"discounted_cash":596.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"METHADONE 10 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J1230","type":"HCPCS"},{"code":"67457-0217-20","type":"NDC"}],"standard_charges":[{"gross_charge":1294.48,"discounted_cash":647.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"44206-0436-05","type":"NDC"}],"standard_charges":[{"gross_charge":1149.69,"discounted_cash":574.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1569","type":"HCPCS"},{"code":"00944-2700-04","type":"NDC"}],"standard_charges":[{"gross_charge":1279.2,"discounted_cash":639.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISAVUCONAZONIUM SULFATE 372 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1833","type":"HCPCS"},{"code":"00469-0420-01","type":"NDC"}],"standard_charges":[{"gross_charge":1157.91,"discounted_cash":578.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 20-100 MCG/ACTUATION INHL MIST","drug_information":{"unit":"4","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00597-0024-02","type":"NDC"}],"standard_charges":[{"gross_charge":1229.84,"discounted_cash":614.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPRATROPIUM-ALBUTEROL 20-100 MCG/ACUTATION MDI - PT OWN SUPPLY","drug_information":{"unit":"4","type":"GR"},"code_information":[{"code":"J3535","type":"HCPCS"},{"code":"00597-0024-02","type":"NDC"}],"standard_charges":[{"gross_charge":1229.84,"discounted_cash":614.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM HYALURONATE (VISCOSUP) 16.8 MG/2 ML IATC SYRG","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J7328","type":"HCPCS"},{"code":"08913-0311-11","type":"NDC"}],"standard_charges":[{"gross_charge":1135.52,"discounted_cash":567.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUNITINIB MALATE 50 MG ORAL CAP","drug_information":{"unit":"28","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00069-0980-38","type":"NDC"}],"standard_charges":[{"gross_charge":1322.35,"discounted_cash":661.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":1197.26,"discounted_cash":598.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNITS/ML INJ SOLN PARTIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1309-01","type":"NDC"}],"standard_charges":[{"gross_charge":1197.26,"discounted_cash":598.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNITS/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1309-04","type":"NDC"}],"standard_charges":[{"gross_charge":1197.26,"discounted_cash":598.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA-EPBX 40000 UNITS/ML INJ SOLN PARTIAL","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"Q5106","type":"HCPCS"},{"code":"00069-1309-04","type":"NDC"}],"standard_charges":[{"gross_charge":1197.26,"discounted_cash":598.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CONJUGATED ESTROGENS 0.625 MG/GRAM VAGL CREA","drug_information":{"unit":"30","type":"GR"},"code_information":[{"code":"00046-0872-21","type":"NDC"}],"standard_charges":[{"gross_charge":1362.76,"discounted_cash":681.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BERACTANT IN 0.9 %SOD.CHLORIDE 25 MG/ML INTR SUS-8 ML","drug_information":{"unit":"8","type":"ML"},"code_information":[{"code":"00074-1040-08","type":"NDC"}],"standard_charges":[{"gross_charge":1436.87,"discounted_cash":718.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"09999-9998-49","type":"NDC"}],"standard_charges":[{"gross_charge":1434.26,"discounted_cash":717.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OPIUM TINCTURE 10 MG/ML ORAL TINC","drug_information":{"unit":"118","type":"ML"},"code_information":[{"code":"62559-0153-04","type":"NDC"}],"standard_charges":[{"gross_charge":1339.95,"discounted_cash":669.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRP","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"70954-0148-10","type":"NDC"}],"standard_charges":[{"gross_charge":1434.26,"discounted_cash":717.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN-THROMBIN 4.8 X 4.8 CM TOP PTMD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"83078-0702-00","type":"NDC"}],"standard_charges":[{"gross_charge":1418.63,"discounted_cash":709.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN-THROMBIN 4.8 X 4.8 CM TOP PTMD","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"83078-0702-02","type":"NDC"}],"standard_charges":[{"gross_charge":1418.63,"discounted_cash":709.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNITS/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"90377","type":"HCPCS"},{"code":"76125-0150-02","type":"NDC"}],"standard_charges":[{"gross_charge":1457.4,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RABIES IMMUNE GLOBULIN (PF) 150 UNITS/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"90377","type":"HCPCS"},{"code":"76125-0150-03","type":"NDC"}],"standard_charges":[{"gross_charge":1457.4,"discounted_cash":728.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 40,000 MCG/20ML (2,000 MCG/ML) IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"25021-0679-20","type":"NDC"}],"standard_charges":[{"gross_charge":1432.28,"discounted_cash":716.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 2000 MCG/ML IT SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"70121-2502-02","type":"NDC"}],"standard_charges":[{"gross_charge":1397.5,"discounted_cash":698.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  60 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0004-01","type":"NDC"}],"standard_charges":[{"gross_charge":1455.02,"discounted_cash":727.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT  60 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0004-04","type":"NDC"}],"standard_charges":[{"gross_charge":1455.02,"discounted_cash":727.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENTOLAMINE 5 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"00143-9564-01","type":"NDC"}],"standard_charges":[{"gross_charge":1404.91,"discounted_cash":702.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PHENTOLAMINE 5 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2760","type":"HCPCS"},{"code":"00143-9564-10","type":"NDC"}],"standard_charges":[{"gross_charge":1404.91,"discounted_cash":702.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 25 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-1232-08","type":"NDC"}],"standard_charges":[{"gross_charge":1378.3,"discounted_cash":689.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 25 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-9733-01","type":"NDC"}],"standard_charges":[{"gross_charge":1378.3,"discounted_cash":689.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREPROSTINIL SODIUM  1 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3285","type":"HCPCS"},{"code":"00703-0666-01","type":"NDC"}],"standard_charges":[{"gross_charge":1345.31,"discounted_cash":672.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYLAN G-F 20 48 MG/6 ML IATC SYRG","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"j7325","type":"HCPCS"},{"code":"05846-8009-03","type":"NDC"}],"standard_charges":[{"gross_charge":1379.96,"discounted_cash":689.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARMUSTINE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9050","type":"HCPCS"},{"code":"72205-0198-01","type":"NDC"}],"standard_charges":[{"gross_charge":1358.18,"discounted_cash":679.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYCLOPHOSPHAMIDE 2 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9075","type":"HCPCS"},{"code":"00781-3255-94","type":"NDC"}],"standard_charges":[{"gross_charge":1341.31,"discounted_cash":670.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DACTINOMYCIN 0.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9120","type":"HCPCS"},{"code":"71288-0129-02","type":"NDC"}],"standard_charges":[{"gross_charge":1438.32,"discounted_cash":719.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB-DYYB 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5103","type":"HCPCS"},{"code":"00069-0809-01","type":"NDC"}],"standard_charges":[{"gross_charge":1433.25,"discounted_cash":716.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"78206-0162-01","type":"NDC"}],"standard_charges":[{"gross_charge":1341.77,"discounted_cash":670.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB-ABDA 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5104","type":"HCPCS"},{"code":"78206-0162-99","type":"NDC"}],"standard_charges":[{"gross_charge":1341.77,"discounted_cash":670.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"70121-1754-01","type":"NDC"}],"standard_charges":[{"gross_charge":1450.03,"discounted_cash":725.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"70121-1754-07","type":"NDC"}],"standard_charges":[{"gross_charge":1450.03,"discounted_cash":725.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MAGGOTS, LIVE MEDICINAL 400 LARVAE PER BAG","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0036-90","type":"NDC"}],"standard_charges":[{"gross_charge":1478.75,"discounted_cash":739.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMDESIVIR 200 MG IVPB - CMP","drug_information":{"unit":"140","type":"ML"},"code_information":[{"code":"09999-9998-45","type":"NDC"}],"standard_charges":[{"gross_charge":1491.49,"discounted_cash":745.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIRSEVIMAB-ALIP 100 MG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90381","type":"HCPCS"},{"code":"49281-0574-15","type":"NDC"}],"standard_charges":[{"gross_charge":1542.35,"discounted_cash":771.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIRSEVIMAB-ALIP 100 MG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90381","type":"HCPCS"},{"code":"49281-0574-88","type":"NDC"}],"standard_charges":[{"gross_charge":1542.35,"discounted_cash":771.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICROFIBRIL. COLLAGEN HEMOSTAT TOP POWD","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"A6010","type":"HCPCS"},{"code":"00998-1010-02","type":"NDC"}],"standard_charges":[{"gross_charge":1508.85,"discounted_cash":754.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECHNETIUM TC 99M TILMANOCEPT KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9520","type":"HCPCS"},{"code":"52579-1600-05","type":"NDC"}],"standard_charges":[{"gross_charge":1471.93,"discounted_cash":735.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHA-1 PROTEINASE INHIB.(HUM) 1000 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0256","type":"HCPCS"},{"code":"13533-0703-10","type":"NDC"}],"standard_charges":[{"gross_charge":1462.5,"discounted_cash":731.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHA-1 PROTEINASE INHIB.(HUM) 1000 MG (+/-)/20 ML IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0256","type":"HCPCS"},{"code":"13533-0705-01","type":"NDC"}],"standard_charges":[{"gross_charge":1495.0,"discounted_cash":747.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALPHA-1 PROTEINASE INHIB.(HUM) 1 GRAM/50 ML (2 %) IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0257","type":"HCPCS"},{"code":"00944-2884-02","type":"NDC"}],"standard_charges":[{"gross_charge":1465.1,"discounted_cash":732.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABOBOTULINUMTOXINA 300 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0586","type":"HCPCS"},{"code":"15054-0530-06","type":"NDC"}],"standard_charges":[{"gross_charge":1494.95,"discounted_cash":747.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INCOBOTULINUMTOXINA 100 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0588","type":"HCPCS"},{"code":"00259-1610-01","type":"NDC"}],"standard_charges":[{"gross_charge":1481.9,"discounted_cash":740.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"25021-0676-20","type":"NDC"}],"standard_charges":[{"gross_charge":1524.82,"discounted_cash":762.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOCILIZUMAB 80 MG/4 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J3262","type":"HCPCS"},{"code":"50242-0135-01","type":"NDC"}],"standard_charges":[{"gross_charge":1486.46,"discounted_cash":743.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 32 MG IATC SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3304","type":"HCPCS"},{"code":"70801-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1524.03,"discounted_cash":762.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 32 MG IATC SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3304","type":"HCPCS"},{"code":"70801-0003-01","type":"NDC"}],"standard_charges":[{"gross_charge":1524.03,"discounted_cash":762.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHACRYNATE SODIUM 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"69315-0701-50","type":"NDC"}],"standard_charges":[{"gross_charge":1459.05,"discounted_cash":729.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTI-HEMOPHILIC FACTOR - VWF (WILATE) S.O","drug_information":{"unit":"495","type":"F2"},"code_information":[{"code":"J7183","type":"HCPCS"},{"code":"68982-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":1508.72,"discounted_cash":754.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 500-500 UNIT IV SOLR","drug_information":{"unit":"495","type":"F2"},"code_information":[{"code":"J7183","type":"HCPCS"},{"code":"68982-0182-01","type":"NDC"}],"standard_charges":[{"gross_charge":1537.43,"discounted_cash":768.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SYRP (ANY SIZE)","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00000-0061-14","type":"NDC"}],"standard_charges":[{"gross_charge":1492.67,"discounted_cash":746.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXYZINE HCL 10 MG/5 ML ORAL SOLN","drug_information":{"unit":"473","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"62135-0750-47","type":"NDC"}],"standard_charges":[{"gross_charge":1492.67,"discounted_cash":746.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEGARELIX 120 MG SUBQ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9155","type":"HCPCS"},{"code":"55566-8402-00","type":"NDC"}],"standard_charges":[{"gross_charge":1465.81,"discounted_cash":732.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEGARELIX 240 MG SUBQ KIT (120 MG SYR X 2)","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9155","type":"HCPCS"},{"code":"55566-8403-01","type":"NDC"}],"standard_charges":[{"gross_charge":1465.81,"discounted_cash":732.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"00069-0315-01","type":"NDC"}],"standard_charges":[{"gross_charge":1491.39,"discounted_cash":745.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-ARRX 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"55513-0224-01","type":"NDC"}],"standard_charges":[{"gross_charge":1483.99,"discounted_cash":742.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-ADCD 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q5129","type":"HCPCS"},{"code":"72606-0011-01","type":"NDC"}],"standard_charges":[{"gross_charge":1492.02,"discounted_cash":746.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DINOPROSTONE 0.5 MG/3 G VAGL GEL","drug_information":{"unit":"3","type":"GR"},"code_information":[{"code":"00009-3359-02","type":"NDC"}],"standard_charges":[{"gross_charge":1542.77,"discounted_cash":771.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE 1 MG/ML SUSPENSION (ANY SIZE)","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"09999-9901-05","type":"NDC"}],"standard_charges":[{"gross_charge":1553.18,"discounted_cash":776.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMLODIPINE BENZOATE 1 MG/ML ORAL SUSP","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"52652-5001-01","type":"NDC"}],"standard_charges":[{"gross_charge":1586.01,"discounted_cash":793.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DINOPROSTONE 10 MG VAGL INER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"55566-2800-00","type":"NDC"}],"standard_charges":[{"gross_charge":1586.65,"discounted_cash":793.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DINOPROSTONE 10 MG VAGL INER","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"55566-2800-01","type":"NDC"}],"standard_charges":[{"gross_charge":1586.65,"discounted_cash":793.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90380","type":"HCPCS"},{"code":"49281-0575-00","type":"NDC"}],"standard_charges":[{"gross_charge":1542.35,"discounted_cash":771.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIRSEVIMAB-ALIP 50 MG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90380","type":"HCPCS"},{"code":"49281-0575-15","type":"NDC"}],"standard_charges":[{"gross_charge":1542.35,"discounted_cash":771.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT FOR PREP TC-99M-SUCCIMER 1 MG IV SOLR","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"A9551","type":"HCPCS"},{"code":"17156-0525-01","type":"NDC"}],"standard_charges":[{"gross_charge":1592.18,"discounted_cash":796.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SULBACTAM-DURLOBACTAM 1 GRAM-1 GRAM (0.5 GRAM X 2) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"68547-0111-10","type":"NDC"}],"standard_charges":[{"gross_charge":1543.75,"discounted_cash":771.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIFOSTINE CRYSTALLINE 500 MG IV SOLR","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"J0207","type":"HCPCS"},{"code":"58178-0017-03","type":"NDC"}],"standard_charges":[{"gross_charge":1583.49,"discounted_cash":791.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0340-00","type":"NDC"}],"standard_charges":[{"gross_charge":1615.47,"discounted_cash":807.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPOETIN ALFA 40000 UNITS INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0885","type":"HCPCS"},{"code":"59676-0340-01","type":"NDC"}],"standard_charges":[{"gross_charge":1615.47,"discounted_cash":807.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 480 MCG/1.6 ML INJ SOLN","drug_information":{"unit":"1.6","type":"ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"55513-0546-01","type":"NDC"}],"standard_charges":[{"gross_charge":1570.73,"discounted_cash":785.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FILGRASTIM 480 MCG/1.6 ML INJ SOLN","drug_information":{"unit":"1.6","type":"ML"},"code_information":[{"code":"J1442","type":"HCPCS"},{"code":"55513-0546-10","type":"NDC"}],"standard_charges":[{"gross_charge":1570.73,"discounted_cash":785.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FOMEPIZOLE 1 G/ML IV SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J1451","type":"HCPCS"},{"code":"70710-1478-01","type":"NDC"}],"standard_charges":[{"gross_charge":1559.45,"discounted_cash":779.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 5 GRAM/50 ML (10 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-20","type":"NDC"}],"standard_charges":[{"gross_charge":1617.04,"discounted_cash":808.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 5 GRAM/50 ML (10 %) INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-21","type":"NDC"}],"standard_charges":[{"gross_charge":1617.04,"discounted_cash":808.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNITS/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"13533-0634-02","type":"NDC"}],"standard_charges":[{"gross_charge":1554.38,"discounted_cash":777.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TETANUS IMMUNE GLOBULIN (PF) 250 UNITS/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1670","type":"HCPCS"},{"code":"13533-0634-20","type":"NDC"}],"standard_charges":[{"gross_charge":1554.38,"discounted_cash":777.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE 39 MG/0.25 ML IM SYRG","drug_information":{"unit":"0.25","type":"ML"},"code_information":[{"code":"J2426","type":"HCPCS"},{"code":"50458-0560-01","type":"NDC"}],"standard_charges":[{"gross_charge":1589.99,"discounted_cash":795.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCAINAMIDE 500 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"14789-0900-02","type":"NDC"}],"standard_charges":[{"gross_charge":1621.16,"discounted_cash":810.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PROCAINAMIDE 500 MG/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J2690","type":"HCPCS"},{"code":"14789-0900-07","type":"NDC"}],"standard_charges":[{"gross_charge":1621.16,"discounted_cash":810.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRALIDOXIME 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2730","type":"HCPCS"},{"code":"60977-0141-01","type":"NDC"}],"standard_charges":[{"gross_charge":1575.21,"discounted_cash":787.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRALIDOXIME 1 G INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2730","type":"HCPCS"},{"code":"60977-0141-27","type":"NDC"}],"standard_charges":[{"gross_charge":1575.21,"discounted_cash":787.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LIDO-BUPIV-HYAL RETROBULBAR BLOCK (COMPOUNDED)","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3471","type":"HCPCS"},{"code":"00000-0001-10","type":"NDC"}],"standard_charges":[{"gross_charge":1593.06,"discounted_cash":796.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARFILZOMIB 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"76075-0103-01","type":"NDC"}],"standard_charges":[{"gross_charge":1583.0,"discounted_cash":791.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-PVVR 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"00069-0238-01","type":"NDC"}],"standard_charges":[{"gross_charge":1548.26,"discounted_cash":774.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB-AXXQ 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5121","type":"HCPCS"},{"code":"55513-0670-01","type":"NDC"}],"standard_charges":[{"gross_charge":1560.65,"discounted_cash":780.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIMODIPINE 30 MG/ML ORAL SOLUTION","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-0000-50","type":"NDC"}],"standard_charges":[{"gross_charge":1687.63,"discounted_cash":843.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM PHOSPHATE, TRIBASIC NF ANHYDROUS POWDER","drug_information":{"unit":"1000","type":"GR"},"code_information":[{"code":"00000-0037-27","type":"NDC"}],"standard_charges":[{"gross_charge":1795.1,"discounted_cash":897.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEXAMETHASONE,MICRONIZED(BULK) 100 % MISC POWD","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"49452-2465-03","type":"NDC"}],"standard_charges":[{"gross_charge":1918.35,"discounted_cash":959.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMINOCAPROIC ACID 250 MG/ML (25 %) ORAL SOLN","drug_information":{"unit":"236.5","type":"ML"},"code_information":[{"code":"52817-0815-08","type":"NDC"}],"standard_charges":[{"gross_charge":1894.2,"discounted_cash":947.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEPATITIS B IMMUNE GLOBULIN GREATER THAN 1,560 UNIT/5 ML IM SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"90371","type":"HCPCS"},{"code":"69800-4203-01","type":"NDC"}],"standard_charges":[{"gross_charge":1823.06,"discounted_cash":911.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LECANEMAB-IRMB 100 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0174","type":"HCPCS"},{"code":"62856-0215-01","type":"NDC"}],"standard_charges":[{"gross_charge":1847.38,"discounted_cash":923.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"REMDESIVIR 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0248","type":"HCPCS"},{"code":"61958-2901-02","type":"NDC"}],"standard_charges":[{"gross_charge":1738.5,"discounted_cash":869.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELIMUMAB 120 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"49401-0101-01","type":"NDC"}],"standard_charges":[{"gross_charge":1804.67,"discounted_cash":902.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 2400000 UNIT/4 ML IM SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0702-04","type":"NDC"}],"standard_charges":[{"gross_charge":1688.57,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 2400000 UNIT/4 ML IM SYRG (PARTIAL)","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0702-04","type":"NDC"}],"standard_charges":[{"gross_charge":1688.57,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 2400000 UNIT/4 ML IM SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0702-10","type":"NDC"}],"standard_charges":[{"gross_charge":1688.57,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENICILLIN G BENZATHINE 2400000 UNIT/4 ML IM SYRG (PARTIAL)","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0561","type":"HCPCS"},{"code":"60793-0702-10","type":"NDC"}],"standard_charges":[{"gross_charge":1688.57,"discounted_cash":844.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONABOTULINUMTOXINA 100 UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0585","type":"HCPCS"},{"code":"00023-1145-01","type":"NDC"}],"standard_charges":[{"gross_charge":1873.4,"discounted_cash":936.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIMABOTULINUMTOXINB 5000 UNITS/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0587","type":"HCPCS"},{"code":"10454-0711-10","type":"NDC"}],"standard_charges":[{"gross_charge":1805.6,"discounted_cash":902.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIMETHYL SULFOXIDE 50 % IVES SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1212","type":"HCPCS"},{"code":"67457-0177-50","type":"NDC"}],"standard_charges":[{"gross_charge":1877.75,"discounted_cash":938.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 37.5 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-1342-08","type":"NDC"}],"standard_charges":[{"gross_charge":1844.84,"discounted_cash":922.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 37.5 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-9734-01","type":"NDC"}],"standard_charges":[{"gross_charge":1844.84,"discounted_cash":922.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TALQUETAMAB-TGVS  2 MG/ML SUBQ SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J3055","type":"HCPCS"},{"code":"57894-0469-01","type":"NDC"}],"standard_charges":[{"gross_charge":1705.55,"discounted_cash":852.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DASATINIB 100 MG ORAL TAB","drug_information":{"unit":"30","type":"UN"},"code_information":[{"code":"J8999","type":"HCPCS"},{"code":"00003-0852-22","type":"NDC"}],"standard_charges":[{"gross_charge":1702.08,"discounted_cash":851.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARATUMUMAB 20 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"57894-0502-05","type":"NDC"}],"standard_charges":[{"gross_charge":1805.3,"discounted_cash":902.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST) IV SOLR","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9330","type":"HCPCS"},{"code":"72611-0780-01","type":"NDC"}],"standard_charges":[{"gross_charge":1789.54,"discounted_cash":894.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEMSIROLIMUS 30 MG/3 ML (10 MG/ML) (FIRST) IV SOLR","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9330","type":"HCPCS"},{"code":"72611-0785-02","type":"NDC"}],"standard_charges":[{"gross_charge":1789.54,"discounted_cash":894.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9350","type":"HCPCS"},{"code":"50242-0159-01","type":"NDC"}],"standard_charges":[{"gross_charge":1774.84,"discounted_cash":887.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMIVIBART 125 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q0224","type":"HCPCS"},{"code":"81960-0031-03","type":"NDC"}],"standard_charges":[{"gross_charge":1860.84,"discounted_cash":930.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"55513-0206-01","type":"NDC"}],"standard_charges":[{"gross_charge":1850.08,"discounted_cash":925.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-ABBS 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"63459-0103-10","type":"NDC"}],"standard_charges":[{"gross_charge":1730.23,"discounted_cash":865.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FLUCYTOSINE 50 MG/ML ORAL SUSPENSION (ANY SIZE)","drug_information":{"unit":"60","type":"ML"},"code_information":[{"code":"00000-8006-08","type":"NDC"}],"standard_charges":[{"gross_charge":2039.81,"discounted_cash":1019.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THROMB,HM-FIBRIN-APROTIN,S-CA 10 ML TOP SYRG","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"00338-9568-01","type":"NDC"}],"standard_charges":[{"gross_charge":2014.52,"discounted_cash":1007.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FENTANYL CITRATE (BULK) 100 % MISC POWD","drug_information":{"unit":"1","type":"GR"},"code_information":[{"code":"00406-1130-52","type":"NDC"}],"standard_charges":[{"gross_charge":1932.19,"discounted_cash":966.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL ALCOHOL 99 % IART SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"54288-0105-02","type":"NDC"}],"standard_charges":[{"gross_charge":2215.59,"discounted_cash":1107.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHYL ALCOHOL 99 % IART SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"54288-0105-15","type":"NDC"}],"standard_charges":[{"gross_charge":2215.59,"discounted_cash":1107.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VITAMIN A PALMITATE 50000 UNITS/ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"70199-0026-11","type":"NDC"}],"standard_charges":[{"gross_charge":1942.02,"discounted_cash":971.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN-THROMBIN 9.5 X 4.8 CM TOP PTMD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"83078-0701-00","type":"NDC"}],"standard_charges":[{"gross_charge":2163.4,"discounted_cash":1081.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN-THROMBIN 9.5 X 4.8 CM TOP PTMD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"83078-0701-01","type":"NDC"}],"standard_charges":[{"gross_charge":2163.4,"discounted_cash":1081.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BACLOFEN 40,000 MCG/20ML (2,000 MCG/ML) IT SYRG","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J0475","type":"HCPCS"},{"code":"66794-0157-01","type":"NDC"}],"standard_charges":[{"gross_charge":1919.75,"discounted_cash":959.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALCITONIN (SALMON) 200 UNITS/ML INJ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0630","type":"HCPCS"},{"code":"42023-0205-01","type":"NDC"}],"standard_charges":[{"gross_charge":2172.37,"discounted_cash":1086.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":2163.88,"discounted_cash":1081.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 100 MCG/ML INJ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0005-04","type":"NDC"}],"standard_charges":[{"gross_charge":2163.88,"discounted_cash":1081.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CHLOROTHIAZIDE 28 MG/ML IV SOLUTION - NICU","drug_information":{"unit":"18","type":"ML"},"code_information":[{"code":"J1205","type":"HCPCS"},{"code":"09999-9997-58","type":"NDC"}],"standard_charges":[{"gross_charge":2071.77,"discounted_cash":1035.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"44206-0437-10","type":"NDC"}],"standard_charges":[{"gross_charge":2051.75,"discounted_cash":1025.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2656-03","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 GRAM IV SOLR - 10%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2656-03","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 GRAM IV SOLR - 5%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2656-03","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2657-07","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 GRAM IV SOLR - 10%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2657-07","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50  5 GRAM IV SOLR - 5%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2657-07","type":"NDC"}],"standard_charges":[{"gross_charge":2194.35,"discounted_cash":1097.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN,GAMMA(IGG)IFAS 10 % IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J1576","type":"HCPCS"},{"code":"68982-0822-03","type":"NDC"}],"standard_charges":[{"gross_charge":2167.46,"discounted_cash":1083.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INTERFERON BETA-1B 0.3 MG SUBQ KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1830","type":"HCPCS"},{"code":"50419-0524-01","type":"NDC"}],"standard_charges":[{"gross_charge":1949.53,"discounted_cash":974.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INTERFERON BETA-1B 0.3 MG SUBQ KIT","drug_information":{"unit":"14","type":"UN"},"code_information":[{"code":"J1830","type":"HCPCS"},{"code":"50419-0524-35","type":"NDC"}],"standard_charges":[{"gross_charge":1949.53,"discounted_cash":974.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE  3.75 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5902-00","type":"NDC"}],"standard_charges":[{"gross_charge":2026.47,"discounted_cash":1013.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE  3.75 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5902-01","type":"NDC"}],"standard_charges":[{"gross_charge":2026.47,"discounted_cash":1013.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF (HUMATE-P) IV S.O.","drug_information":{"unit":"600","type":"UN"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"63833-0615-02","type":"NDC"}],"standard_charges":[{"gross_charge":1983.6,"discounted_cash":991.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONATE SODIUM, STABILIZED 88 MG/4 ML IATC SYRG","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J7327","type":"HCPCS"},{"code":"05967-6820-01","type":"NDC"}],"standard_charges":[{"gross_charge":1958.06,"discounted_cash":979.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETUXIMAB 100 MG/50 ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"66733-0948-23","type":"NDC"}],"standard_charges":[{"gross_charge":2250.26,"discounted_cash":1125.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-QYYP 150 MG IV SOLR","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"Q5116","type":"HCPCS"},{"code":"00069-0308-01","type":"NDC"}],"standard_charges":[{"gross_charge":2174.13,"discounted_cash":1087.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.05 % TOP OINT","drug_information":{"unit":"430","type":"GR"},"code_information":[{"code":"67857-0806-19","type":"NDC"}],"standard_charges":[{"gross_charge":2436.64,"discounted_cash":1218.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABOBOTULINUMTOXINA 500 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0586","type":"HCPCS"},{"code":"15054-0500-01","type":"NDC"}],"standard_charges":[{"gross_charge":2491.1,"discounted_cash":1245.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INCOBOTULINUMTOXINA 200 UNITS IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0588","type":"HCPCS"},{"code":"00259-1620-01","type":"NDC"}],"standard_charges":[{"gross_charge":2657.2,"discounted_cash":1328.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CYTOMEGALOVIRUS IMMUNE GLOB 50 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J0850","type":"HCPCS"},{"code":"44206-3101-01","type":"NDC"}],"standard_charges":[{"gross_charge":2461.38,"discounted_cash":1230.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETANERCEPT 25 MG/0.5 ML SUBQ SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1438","type":"HCPCS"},{"code":"58406-0055-01","type":"NDC"}],"standard_charges":[{"gross_charge":2666.95,"discounted_cash":1333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETANERCEPT 25 MG/0.5 ML SUBQ SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1438","type":"HCPCS"},{"code":"58406-0055-04","type":"NDC"}],"standard_charges":[{"gross_charge":2666.95,"discounted_cash":1333.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1569","type":"HCPCS"},{"code":"00944-2700-05","type":"NDC"}],"standard_charges":[{"gross_charge":2282.88,"discounted_cash":1141.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"57894-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":2274.66,"discounted_cash":1137.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INFLIXIMAB 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1745","type":"HCPCS"},{"code":"57894-0160-01","type":"NDC"}],"standard_charges":[{"gross_charge":2274.66,"discounted_cash":1137.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZICONOTIDE 5 MCG/ML IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2278","type":"HCPCS"},{"code":"00000-0001-42","type":"NDC"}],"standard_charges":[{"gross_charge":2407.0,"discounted_cash":1203.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 50 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-1453-08","type":"NDC"}],"standard_charges":[{"gross_charge":2459.81,"discounted_cash":1229.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISPERIDONE MICROSPHERES 50 MG/2 ML IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2794","type":"HCPCS"},{"code":"00480-9735-01","type":"NDC"}],"standard_charges":[{"gross_charge":2459.81,"discounted_cash":1229.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SECRETIN (HUMAN) 16 MCG IV SOLR","drug_information":{"unit":"0.016","type":"ME"},"code_information":[{"code":"J2850","type":"HCPCS"},{"code":"67066-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":2506.18,"discounted_cash":1253.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIAMCINOLONE ACETONIDE (PF) 40 MG/ML IO SUSP","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3300","type":"HCPCS"},{"code":"00065-0543-01","type":"NDC"}],"standard_charges":[{"gross_charge":2550.64,"discounted_cash":1275.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN 1 GRAM (700 MG- 1,300 MG) IV SOLR","drug_information":{"unit":"1048","type":"ME"},"code_information":[{"code":"J7177","type":"HCPCS"},{"code":"68982-0347-01","type":"NDC"}],"standard_charges":[{"gross_charge":2400.97,"discounted_cash":1200.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL (XYNTHA) S.O.","drug_information":{"unit":"1010","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0014-01","type":"NDC"}],"standard_charges":[{"gross_charge":2489.65,"discounted_cash":1244.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL 1,000 (+/-) UNIT IV SOLN","drug_information":{"unit":"1010","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0014-01","type":"NDC"}],"standard_charges":[{"gross_charge":2489.65,"discounted_cash":1244.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 1000 UNITS IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7195","type":"HCPCS"},{"code":"58394-0635-03","type":"NDC"}],"standard_charges":[{"gross_charge":2652.0,"discounted_cash":1326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONATE SODIUM, STABILIZED 60 MG/3 ML IATC SYRG","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J7318","type":"HCPCS"},{"code":"08913-0202-01","type":"NDC"}],"standard_charges":[{"gross_charge":2604.11,"discounted_cash":1302.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POSACONAZOLE 200 MG/5 ML ORAL SUSP (ANY SIZE POD)","drug_information":{"unit":"105","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00000-0040-81","type":"NDC"}],"standard_charges":[{"gross_charge":2663.47,"discounted_cash":1331.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POSACONAZOLE 200 MG/5 ML (40 MG/ML) ORAL SUSP","drug_information":{"unit":"105","type":"ML"},"code_information":[{"code":"J8499","type":"HCPCS"},{"code":"00254-1016-36","type":"NDC"}],"standard_charges":[{"gross_charge":2663.47,"discounted_cash":1331.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"50242-0060-01","type":"NDC"}],"standard_charges":[{"gross_charge":2388.17,"discounted_cash":1194.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 25 MG/ML NICU INTRAVITREAL","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"50242-0060-01","type":"NDC"}],"standard_charges":[{"gross_charge":2388.17,"discounted_cash":1194.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"63020-0049-01","type":"NDC"}],"standard_charges":[{"gross_charge":2351.38,"discounted_cash":1175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG INJ SOLR 2.5 MG/ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"63020-0049-01","type":"NDC"}],"standard_charges":[{"gross_charge":2351.38,"discounted_cash":1175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"71288-0118-10","type":"NDC"}],"standard_charges":[{"gross_charge":2351.38,"discounted_cash":1175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BORTEZOMIB 3.5 MG INJ SOLR 2.5 MG/ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9041","type":"HCPCS"},{"code":"71288-0118-10","type":"NDC"}],"standard_charges":[{"gross_charge":2351.38,"discounted_cash":1175.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISATUXIMAB-IRFC 20 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9227","type":"HCPCS"},{"code":"00024-0654-01","type":"NDC"}],"standard_charges":[{"gross_charge":2295.33,"discounted_cash":1147.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZIV-AFLIBERCEPT 100 MG/4 ML (25 MG/ML) IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9400","type":"HCPCS"},{"code":"00024-5840-01","type":"NDC"}],"standard_charges":[{"gross_charge":2320.0,"discounted_cash":1160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DKST 150 MG IV SOLR","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"Q5114","type":"HCPCS"},{"code":"67457-0991-15","type":"NDC"}],"standard_charges":[{"gross_charge":2485.2,"discounted_cash":1242.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NATAMYCIN 5 % OPHT DRPS","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"71776-0005-15","type":"NDC"}],"standard_charges":[{"gross_charge":2746.29,"discounted_cash":1373.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AGALSIDASE BETA  5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0180","type":"HCPCS"},{"code":"58468-0041-01","type":"NDC"}],"standard_charges":[{"gross_charge":2855.17,"discounted_cash":1427.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELATACEPT 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0485","type":"HCPCS"},{"code":"00003-0371-13","type":"NDC"}],"standard_charges":[{"gross_charge":2812.66,"discounted_cash":1406.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC CARBOXYMALTOSE 50 MG IRON/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J1439","type":"HCPCS"},{"code":"00517-0650-01","type":"NDC"}],"standard_charges":[{"gross_charge":2758.6,"discounted_cash":1379.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 10 GRAM/100 ML (10 %) INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-71","type":"NDC"}],"standard_charges":[{"gross_charge":2899.52,"discounted_cash":1449.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 10 GRAM/100 ML (10 %) INJ SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-72","type":"NDC"}],"standard_charges":[{"gross_charge":2899.52,"discounted_cash":1449.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZICONOTIDE 100 MCG/ML IT SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2278","type":"HCPCS"},{"code":"70720-0720-10","type":"NDC"}],"standard_charges":[{"gross_charge":2894.74,"discounted_cash":1447.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORITAVANCIN  400 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"70842-0140-01","type":"NDC"}],"standard_charges":[{"gross_charge":2806.32,"discounted_cash":1403.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORITAVANCIN  400 MG IV SOLR","drug_information":{"unit":"3","type":"UN"},"code_information":[{"code":"J2407","type":"HCPCS"},{"code":"70842-0140-03","type":"NDC"}],"standard_charges":[{"gross_charge":2806.32,"discounted_cash":1403.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE 78 MG/0.5 ML IM SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J2426","type":"HCPCS"},{"code":"50458-0561-01","type":"NDC"}],"standard_charges":[{"gross_charge":2851.09,"discounted_cash":1425.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASBURICASE 1.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2783","type":"HCPCS"},{"code":"00024-5150-10","type":"NDC"}],"standard_charges":[{"gross_charge":2793.75,"discounted_cash":1396.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASBURICASE 1.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2783","type":"HCPCS"},{"code":"00024-5150-11","type":"NDC"}],"standard_charges":[{"gross_charge":2793.75,"discounted_cash":1396.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RASBURICASE 1.5 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2783","type":"HCPCS"},{"code":"00024-5154-11","type":"NDC"}],"standard_charges":[{"gross_charge":2793.75,"discounted_cash":1396.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RESLIZUMAB 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2786","type":"HCPCS"},{"code":"59310-0610-31","type":"NDC"}],"standard_charges":[{"gross_charge":2784.6,"discounted_cash":1392.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREPROSTINIL SODIUM  2.5 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3285","type":"HCPCS"},{"code":"00703-0676-01","type":"NDC"}],"standard_charges":[{"gross_charge":2690.59,"discounted_cash":1345.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXOCOBALAMIN (CYANOKIT) INFUSION - ONE LINE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3424","type":"HCPCS"},{"code":"50633-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":2696.54,"discounted_cash":1348.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYDROXOCOBALAMIN 5 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3424","type":"HCPCS"},{"code":"50633-0310-11","type":"NDC"}],"standard_charges":[{"gross_charge":2696.54,"discounted_cash":1348.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"63833-0386-02","type":"NDC"}],"standard_charges":[{"gross_charge":2682.5,"discounted_cash":1341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HUM PROTHROMBIN CPLX(PCC)4FACT 500 UNIT (400-620 UNIT) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7168","type":"HCPCS"},{"code":"63833-0396-01","type":"NDC"}],"standard_charges":[{"gross_charge":2682.5,"discounted_cash":1341.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTI-HEMOPHILIC FACTOR - VWF (WILATE) S.O","drug_information":{"unit":"1010","type":"F2"},"code_information":[{"code":"J7183","type":"HCPCS"},{"code":"68982-0182-02","type":"NDC"}],"standard_charges":[{"gross_charge":2759.93,"discounted_cash":1379.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF 1,000-1,000 UNIT IV SOLR","drug_information":{"unit":"1010","type":"F2"},"code_information":[{"code":"J7183","type":"HCPCS"},{"code":"68982-0182-02","type":"NDC"}],"standard_charges":[{"gross_charge":2707.41,"discounted_cash":1353.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURVALUMAB 50 MG/ML IV SOLN","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"J9173","type":"HCPCS"},{"code":"00310-4500-12","type":"NDC"}],"standard_charges":[{"gross_charge":2873.03,"discounted_cash":1436.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GOSERELIN  3.6 MG SUBQ IMPL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"70720-0950-36","type":"NDC"}],"standard_charges":[{"gross_charge":2879.18,"discounted_cash":1439.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PACLITAXEL PROTEIN-BOUND 100 MG IV SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9264","type":"HCPCS"},{"code":"00781-3531-91","type":"NDC"}],"standard_charges":[{"gross_charge":2815.01,"discounted_cash":1407.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB 10 MG/ML IV CONC","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"50242-0051-21","type":"NDC"}],"standard_charges":[{"gross_charge":2724.61,"discounted_cash":1362.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB 10 MG/ML IV CONC FOR DESENSITIZATION","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"50242-0051-21","type":"NDC"}],"standard_charges":[{"gross_charge":2724.61,"discounted_cash":1362.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SUBQ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"67457-0220-00","type":"NDC"}],"standard_charges":[{"gross_charge":2837.8,"discounted_cash":1418.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ISOSULFAN BLUE 1 % SUBQ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"Q9968","type":"HCPCS"},{"code":"67457-0220-05","type":"NDC"}],"standard_charges":[{"gross_charge":2837.8,"discounted_cash":1418.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGINTERFERON ALFA-2A 180 MCG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"S0145","type":"HCPCS"},{"code":"82154-0449-01","type":"NDC"}],"standard_charges":[{"gross_charge":2697.19,"discounted_cash":1348.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM 10 MG/ML ORAL SOLN (ANY SIZE)","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"00000-0000-79","type":"NDC"}],"standard_charges":[{"gross_charge":3481.14,"discounted_cash":1740.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COCAINE (BULK) 100 % MISC CRYS","drug_information":{"unit":"25","type":"GR"},"code_information":[{"code":"00406-1520-55","type":"NDC"}],"standard_charges":[{"gross_charge":3393.14,"discounted_cash":1696.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRIVARACETAM 10 MG/ML ORAL SOLN","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"50474-0870-15","type":"NDC"}],"standard_charges":[{"gross_charge":3481.14,"discounted_cash":1740.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT PREP TC-99M-EXAMETAZIME 0.5 MG IV KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9521","type":"HCPCS"},{"code":"17156-0023-05","type":"NDC"}],"standard_charges":[{"gross_charge":3432.72,"discounted_cash":1716.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TC-99M-EXAMETAZIME CERETEC LABELED WBC 0.5 MG IV KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9521","type":"HCPCS"},{"code":"17156-0023-05","type":"NDC"}],"standard_charges":[{"gross_charge":3432.72,"discounted_cash":1716.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONABOTULINUMTOXINA 200 UNITS INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0585","type":"HCPCS"},{"code":"00023-3921-02","type":"NDC"}],"standard_charges":[{"gross_charge":3359.2,"discounted_cash":1679.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RIMABOTULINUMTOXINB 10000 UNIT/2 ML IM SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0587","type":"HCPCS"},{"code":"10454-0712-10","type":"NDC"}],"standard_charges":[{"gross_charge":3237.63,"discounted_cash":1618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0027-01","type":"NDC"}],"standard_charges":[{"gross_charge":2910.05,"discounted_cash":1455.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 150 MCG/0.3 ML INJ SYRG","drug_information":{"unit":"0.3","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0027-04","type":"NDC"}],"standard_charges":[{"gross_charge":2910.05,"discounted_cash":1455.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOBARBITAL SODIUM 50 MG/ML INJ SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J2515","type":"HCPCS"},{"code":"25021-0676-50","type":"NDC"}],"standard_charges":[{"gross_charge":3417.7,"discounted_cash":1708.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM 125 MCG SUBQ SOLR","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"J2796","type":"HCPCS"},{"code":"55513-0223-01","type":"NDC"}],"standard_charges":[{"gross_charge":3408.6,"discounted_cash":1704.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM SYRINGE","drug_information":{"unit":"0.125","type":"ME"},"code_information":[{"code":"J2796","type":"HCPCS"},{"code":"55513-0223-01","type":"NDC"}],"standard_charges":[{"gross_charge":3408.6,"discounted_cash":1704.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBQ SYRG","drug_information":{"unit":"1.17","type":"ML"},"code_information":[{"code":"J3111","type":"HCPCS"},{"code":"55513-0998-02","type":"NDC"}],"standard_charges":[{"gross_charge":3254.87,"discounted_cash":1627.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOCILIZUMAB 200 MG/10 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J3262","type":"HCPCS"},{"code":"50242-0136-01","type":"NDC"}],"standard_charges":[{"gross_charge":3331.75,"discounted_cash":1665.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FIBRINOGEN CONCENTRATE (RIASTAP) KIT","drug_information":{"unit":"934","type":"ME"},"code_information":[{"code":"J7178","type":"HCPCS"},{"code":"63833-0891-51","type":"NDC"}],"standard_charges":[{"gross_charge":3016.08,"discounted_cash":1508.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVONORGESTREL 17.5 MCG/24 HR (5 YRS) 19.5 MG IU IUD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7296","type":"HCPCS"},{"code":"50419-0424-01","type":"NDC"}],"standard_charges":[{"gross_charge":3007.66,"discounted_cash":1503.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEVONORGESTREL 1 EACH IU IUD","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7298","type":"HCPCS"},{"code":"50419-0423-01","type":"NDC"}],"standard_charges":[{"gross_charge":3007.66,"discounted_cash":1503.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HYALURONATE SOD, CROSS-LINKED 30 MG/3 ML IATC SYRG","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J7326","type":"HCPCS"},{"code":"05001-6957-11","type":"NDC"}],"standard_charges":[{"gross_charge":2990.0,"discounted_cash":1495.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALDESLEUKIN 22 MILLION UNITS IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9015","type":"HCPCS"},{"code":"00078-0495-61","type":"NDC"}],"standard_charges":[{"gross_charge":2917.05,"discounted_cash":1458.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IXABEPILONE 15 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9207","type":"HCPCS"},{"code":"00015-1910-12","type":"NDC"}],"standard_charges":[{"gross_charge":2921.99,"discounted_cash":1461.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 40 MG/4 ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9299","type":"HCPCS"},{"code":"00003-3772-11","type":"NDC"}],"standard_charges":[{"gross_charge":3308.35,"discounted_cash":1654.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPCORITAMAB-BYSP  4 MG/0.8 ML SUBQ SOLN","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"82705-0002-01","type":"NDC"}],"standard_charges":[{"gross_charge":3432.08,"discounted_cash":1716.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DTTB 150 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5112","type":"HCPCS"},{"code":"00006-5033-01","type":"NDC"}],"standard_charges":[{"gross_charge":3064.07,"discounted_cash":1532.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DTTB 150 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5112","type":"HCPCS"},{"code":"00006-5033-02","type":"NDC"}],"standard_charges":[{"gross_charge":3064.07,"discounted_cash":1532.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-ANNS 150 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5117","type":"HCPCS"},{"code":"55513-0141-01","type":"NDC"}],"standard_charges":[{"gross_charge":3396.18,"discounted_cash":1698.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 400 ML SC 5 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-15","type":"NDC"}],"standard_charges":[{"gross_charge":3779.96,"discounted_cash":1889.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 400 ML DC 4 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-75","type":"NDC"}],"standard_charges":[{"gross_charge":3779.96,"discounted_cash":1889.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"QUADRASPHERE MICROSPHERES 30-60 MICROMETERS 10 ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-80","type":"NDC"}],"standard_charges":[{"gross_charge":3640.0,"discounted_cash":1820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMPANEL 0.5 MG/ML ORAL SUSP (ANY SIZE)","drug_information":{"unit":"340","type":"ML"},"code_information":[{"code":"09999-9997-60","type":"NDC"}],"standard_charges":[{"gross_charge":3839.22,"discounted_cash":1919.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ETHIODIZED OIL 480 MG IODINE/ML INJ OIL","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"67684-1901-02","type":"NDC"}],"standard_charges":[{"gross_charge":3723.2,"discounted_cash":1861.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERAMPANEL 0.5 MG/ML ORAL SUSP","drug_information":{"unit":"340","type":"ML"},"code_information":[{"code":"69616-0290-38","type":"NDC"}],"standard_charges":[{"gross_charge":3839.22,"discounted_cash":1919.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ABATACEPT (WITH MALTOSE) 250 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0129","type":"HCPCS"},{"code":"00003-2187-13","type":"NDC"}],"standard_charges":[{"gross_charge":3669.38,"discounted_cash":1834.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALLOPURINOL SODIUM 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0206","type":"HCPCS"},{"code":"65219-0380-30","type":"NDC"}],"standard_charges":[{"gross_charge":3531.87,"discounted_cash":1765.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELOSULFASE ALFA 5 MG/5 ML (1 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J1322","type":"HCPCS"},{"code":"68135-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":3694.6,"discounted_cash":1847.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-PRO-IGA 0-50 10 % IV SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1459","type":"HCPCS"},{"code":"44206-0438-20","type":"NDC"}],"standard_charges":[{"gross_charge":3679.0,"discounted_cash":1839.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE LAUROXIL 441 MG/1.6 ML IM SERS","drug_information":{"unit":"1.6","type":"ML"},"code_information":[{"code":"J1944","type":"HCPCS"},{"code":"65757-0401-03","type":"NDC"}],"standard_charges":[{"gross_charge":3741.82,"discounted_cash":1870.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OMALIZUMAB 150 MG SUBQ SOLR","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"J2357","type":"HCPCS"},{"code":"50242-0040-62","type":"NDC"}],"standard_charges":[{"gross_charge":3600.87,"discounted_cash":1800.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VELAGLUCERASE ALFA 400 UNITS IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3385","type":"HCPCS"},{"code":"54092-0701-04","type":"NDC"}],"standard_charges":[{"gross_charge":3798.24,"discounted_cash":1899.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFIBROTIDE 80 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"68727-0800-01","type":"NDC"}],"standard_charges":[{"gross_charge":3550.56,"discounted_cash":1775.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DEFIBROTIDE 80 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J3490","type":"HCPCS"},{"code":"68727-0800-02","type":"NDC"}],"standard_charges":[{"gross_charge":3550.56,"discounted_cash":1775.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF (HUMATE-P) IV S.O.","drug_information":{"unit":"1200","type":"UN"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"63833-0616-02","type":"NDC"}],"standard_charges":[{"gross_charge":3556.8,"discounted_cash":1778.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENDAMUSTINE 25 MG/ML IV SOLN (BENDEKA)","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9034","type":"HCPCS"},{"code":"63459-0348-04","type":"NDC"}],"standard_charges":[{"gross_charge":3724.07,"discounted_cash":1862.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERIBULIN 1 MG/2 ML (0.5 MG/ML) CHEMO SYRINGE","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9179","type":"HCPCS"},{"code":"62856-0389-01","type":"NDC"}],"standard_charges":[{"gross_charge":3666.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ERIBULIN 1 MG/2 ML (0.5 MG/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9179","type":"HCPCS"},{"code":"62856-0389-01","type":"NDC"}],"standard_charges":[{"gross_charge":3666.0,"discounted_cash":1833.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMUCIRUMAB 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9308","type":"HCPCS"},{"code":"00002-7669-01","type":"NDC"}],"standard_charges":[{"gross_charge":3787.66,"discounted_cash":1893.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAFASITAMAB-CXIX 200 MG IV SOLR","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9349","type":"HCPCS"},{"code":"73535-0208-01","type":"NDC"}],"standard_charges":[{"gross_charge":3505.32,"discounted_cash":1752.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECLISTAMAB-CQYV 10 MG/ML SUBQ SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J9380","type":"HCPCS"},{"code":"57894-0449-01","type":"NDC"}],"standard_charges":[{"gross_charge":3616.3,"discounted_cash":1808.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-PKRB 150 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5113","type":"HCPCS"},{"code":"63459-0303-43","type":"NDC"}],"standard_charges":[{"gross_charge":3573.57,"discounted_cash":1786.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ORPHENADRINE CITRATE (BULK) MISC POWD","drug_information":{"unit":"1000","type":"GR"},"code_information":[{"code":"38779-0452-09","type":"NDC"}],"standard_charges":[{"gross_charge":4399.2,"discounted_cash":2199.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANGIOTENSIN II 2.5 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"68547-0501-02","type":"NDC"}],"standard_charges":[{"gross_charge":4212.0,"discounted_cash":2106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTETATE INDIUM DISOD. IN-111 1.5 MCI/1.5 ML IT SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"A9548","type":"HCPCS"},{"code":"17156-0251-08","type":"NDC"}],"standard_charges":[{"gross_charge":4455.83,"discounted_cash":2227.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TARLATAMAB-DLLE  1 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9170","type":"HCPCS"},{"code":"55513-0059-01","type":"NDC"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":1950.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DALBAVANCIN 500 MG IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0875","type":"HCPCS"},{"code":"57970-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":4094.33,"discounted_cash":2047.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 200 MCG/0.4 ML INJ SYRG","drug_information":{"unit":"0.4","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0028-01","type":"NDC"}],"standard_charges":[{"gross_charge":3880.06,"discounted_cash":1940.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DENOSUMAB 60 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"55513-0710-21","type":"NDC"}],"standard_charges":[{"gross_charge":4481.39,"discounted_cash":2240.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRILACICLIB 300 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1448","type":"HCPCS"},{"code":"73462-0101-01","type":"NDC"}],"standard_charges":[{"gross_charge":4032.85,"discounted_cash":2016.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2658-04","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 GRAM IV SOLR - 10%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2658-04","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 GRAM IV SOLR - 5%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2658-04","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 G IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2659-08","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 GRAM IV SOLR - 10%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2659-08","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G-GLY-GLUC-IGA 0-50 10 GRAM IV SOLR - 5%","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1566","type":"HCPCS"},{"code":"00944-2659-08","type":"NDC"}],"standard_charges":[{"gross_charge":3934.66,"discounted_cash":1967.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % INJ SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1569","type":"HCPCS"},{"code":"00944-2700-06","type":"NDC"}],"standard_charges":[{"gross_charge":4093.44,"discounted_cash":2046.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN,GAMMA(IGG)IFAS 10 % IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J1576","type":"HCPCS"},{"code":"68982-0822-04","type":"NDC"}],"standard_charges":[{"gross_charge":3886.48,"discounted_cash":1943.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE  3.75 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1950","type":"HCPCS"},{"code":"00074-3641-03","type":"NDC"}],"standard_charges":[{"gross_charge":4303.81,"discounted_cash":2151.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALTREXONE MICROSPHERES 380 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2315","type":"HCPCS"},{"code":"65757-0300-01","type":"NDC"}],"standard_charges":[{"gross_charge":4117.57,"discounted_cash":2058.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NALTREXONE MICROSPHERES 380 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2315","type":"HCPCS"},{"code":"65757-0302-02","type":"NDC"}],"standard_charges":[{"gross_charge":4117.57,"discounted_cash":2058.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE 117 MG/0.75 ML IM SYRG","drug_information":{"unit":"0.75","type":"ML"},"code_information":[{"code":"J2426","type":"HCPCS"},{"code":"50458-0562-01","type":"NDC"}],"standard_charges":[{"gross_charge":4276.72,"discounted_cash":2138.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL (XYNTHA) S.O.","drug_information":{"unit":"1940","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0015-01","type":"NDC"}],"standard_charges":[{"gross_charge":4287.4,"discounted_cash":2143.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,B-DOM DEL 2,000 (+/-) UNIT IV SOLN","drug_information":{"unit":"1940","type":"F2"},"code_information":[{"code":"J7185","type":"HCPCS"},{"code":"58394-0015-01","type":"NDC"}],"standard_charges":[{"gross_charge":4287.4,"discounted_cash":2143.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARFILZOMIB 30 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"76075-0102-01","type":"NDC"}],"standard_charges":[{"gross_charge":4257.71,"discounted_cash":2128.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CETUXIMAB 200 MG/100 ML IV SOLN","drug_information":{"unit":"100","type":"ML"},"code_information":[{"code":"J9055","type":"HCPCS"},{"code":"66733-0958-23","type":"NDC"}],"standard_charges":[{"gross_charge":4034.94,"discounted_cash":2017.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANITUMUMAB 100 MG/5 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9303","type":"HCPCS"},{"code":"55513-0954-01","type":"NDC"}],"standard_charges":[{"gross_charge":4328.56,"discounted_cash":2164.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB 150 MG FOR DESENSITIZATION PROTOCOL","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"50242-0132-01","type":"NDC"}],"standard_charges":[{"gross_charge":4051.71,"discounted_cash":2025.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB 150 MG IV SOLR","drug_information":{"unit":"150","type":"ME"},"code_information":[{"code":"J9355","type":"HCPCS"},{"code":"50242-0132-01","type":"NDC"}],"standard_charges":[{"gross_charge":4051.71,"discounted_cash":2025.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-JMDB 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"Q5108","type":"HCPCS"},{"code":"83257-0005-41","type":"NDC"}],"standard_charges":[{"gross_charge":4140.51,"discounted_cash":2070.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-CBQV 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"Q5111","type":"HCPCS"},{"code":"70114-0101-01","type":"NDC"}],"standard_charges":[{"gross_charge":4331.61,"discounted_cash":2165.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 100 ML SC 2 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-76","type":"NDC"}],"standard_charges":[{"gross_charge":5255.25,"discounted_cash":2627.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 400 ML SC VARIABLE 2-14 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-78","type":"NDC"}],"standard_charges":[{"gross_charge":5255.25,"discounted_cash":2627.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 600 ML SC VARIABLE 2-14 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-79","type":"NDC"}],"standard_charges":[{"gross_charge":5255.25,"discounted_cash":2627.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ON-Q PAIN PUMP 400 ML DC VARIABLE 1-7 ML/HR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-0091-88","type":"NDC"}],"standard_charges":[{"gross_charge":5255.25,"discounted_cash":2627.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ONCOZENE MICROSPHERES 100 +/- 25 MICON 2 ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00000-8000-37","type":"NDC"}],"standard_charges":[{"gross_charge":4680.0,"discounted_cash":2340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GELATIN ABSORBABLE IMPL FILM","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"00009-0283-01","type":"NDC"}],"standard_charges":[{"gross_charge":5092.44,"discounted_cash":2546.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DANTROLENE 250 MG IV SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"42367-0540-32","type":"NDC"}],"standard_charges":[{"gross_charge":5365.49,"discounted_cash":2682.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIVIZUMAB IM SYRINGE","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90378","type":"HCPCS"},{"code":"60574-4114-01","type":"NDC"}],"standard_charges":[{"gross_charge":4733.72,"discounted_cash":2366.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIVIZUMAB 50 MG/0.5 ML IM SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"90378","type":"HCPCS"},{"code":"66658-0230-01","type":"NDC"}],"standard_charges":[{"gross_charge":4733.72,"discounted_cash":2366.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SUTIMLIMAB-JOME 50 MG/ML IV SOLN","drug_information":{"unit":"22","type":"ML"},"code_information":[{"code":"J1302","type":"HCPCS"},{"code":"80203-0347-01","type":"NDC"}],"standard_charges":[{"gross_charge":4985.79,"discounted_cash":2492.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GOLIMUMAB  12.5 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J1602","type":"HCPCS"},{"code":"57894-0350-01","type":"NDC"}],"standard_charges":[{"gross_charge":5013.48,"discounted_cash":2506.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREPROSTINIL SODIUM  5 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3285","type":"HCPCS"},{"code":"00703-0686-01","type":"NDC"}],"standard_charges":[{"gross_charge":5381.17,"discounted_cash":2690.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"USTEKINUMAB 130 MG/26 ML IV SOLN","drug_information":{"unit":"26","type":"ML"},"code_information":[{"code":"J3358","type":"HCPCS"},{"code":"57894-0054-27","type":"NDC"}],"standard_charges":[{"gross_charge":5261.11,"discounted_cash":2630.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COAGULATION FACTOR IX (RECOMB) 2000 UNITS IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7195","type":"HCPCS"},{"code":"58394-0636-03","type":"NDC"}],"standard_charges":[{"gross_charge":5304.0,"discounted_cash":2652.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTI-INHIBITOR COAGULANT CMPLX 700-1,300 UNIT IV SOLR","drug_information":{"unit":"1000","type":"UN"},"code_information":[{"code":"J7198","type":"HCPCS"},{"code":"64193-0424-02","type":"NDC"}],"standard_charges":[{"gross_charge":5226.0,"discounted_cash":2613.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AVELUMAB 20 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9023","type":"HCPCS"},{"code":"44087-3535-01","type":"NDC"}],"standard_charges":[{"gross_charge":5033.71,"discounted_cash":2516.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE  7.5 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"00074-3642-03","type":"NDC"}],"standard_charges":[{"gross_charge":5128.66,"discounted_cash":2564.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":"420","type":"ME"},"code_information":[{"code":"Q5114","type":"HCPCS"},{"code":"67457-0845-50","type":"NDC"}],"standard_charges":[{"gross_charge":4519.79,"discounted_cash":2259.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DKST 420 MG IV SOLR","drug_information":{"unit":"420","type":"ME"},"code_information":[{"code":"Q5114","type":"HCPCS"},{"code":"67457-0847-44","type":"NDC"}],"standard_charges":[{"gross_charge":4519.79,"discounted_cash":2259.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-BVZR 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"Q5118","type":"HCPCS"},{"code":"00069-0342-01","type":"NDC"}],"standard_charges":[{"gross_charge":5348.43,"discounted_cash":2674.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-APGF 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"Q5122","type":"HCPCS"},{"code":"00069-0324-01","type":"NDC"}],"standard_charges":[{"gross_charge":5223.48,"discounted_cash":2611.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"70121-1755-01","type":"NDC"}],"standard_charges":[{"gross_charge":5200.09,"discounted_cash":2600.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-MALY 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"Q5126","type":"HCPCS"},{"code":"70121-1755-07","type":"NDC"}],"standard_charges":[{"gross_charge":5200.09,"discounted_cash":2600.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-ADCD 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"Q5129","type":"HCPCS"},{"code":"72606-0012-01","type":"NDC"}],"standard_charges":[{"gross_charge":5350.68,"discounted_cash":2675.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MICROFIBRIL. COLLAGEN HEMOSTAT TOP POWD","drug_information":{"unit":"5","type":"GR"},"code_information":[{"code":"A6010","type":"HCPCS"},{"code":"00998-1010-59","type":"NDC"}],"standard_charges":[{"gross_charge":6035.38,"discounted_cash":3017.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELIMUMAB 400 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0490","type":"HCPCS"},{"code":"49401-0102-01","type":"NDC"}],"standard_charges":[{"gross_charge":5392.98,"discounted_cash":2696.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CRIZANLIZUMAB-TMCA 10 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J0791","type":"HCPCS"},{"code":"00078-0883-61","type":"NDC"}],"standard_charges":[{"gross_charge":6377.65,"discounted_cash":3188.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 300 MCG/0.6 ML INJ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0111-01","type":"NDC"}],"standard_charges":[{"gross_charge":5820.1,"discounted_cash":2910.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FERRIC DERISOMALTOSE 100 MG IRON/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J1437","type":"HCPCS"},{"code":"73594-9310-01","type":"NDC"}],"standard_charges":[{"gross_charge":6061.75,"discounted_cash":3030.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 20 GRAM/200 ML (10 %) INJ SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-24","type":"NDC"}],"standard_charges":[{"gross_charge":5799.04,"discounted_cash":2899.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBUL G-GLY-IGA AVG 46 20 GRAM/200 ML (10 %) INJ SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1561","type":"HCPCS"},{"code":"13533-0800-25","type":"NDC"}],"standard_charges":[{"gross_charge":5799.04,"discounted_cash":2899.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUN GLOB G(IGG)-GLY-IGA OV50 10 % INJ SOLN","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J1569","type":"HCPCS"},{"code":"00944-2700-07","type":"NDC"}],"standard_charges":[{"gross_charge":6140.16,"discounted_cash":3070.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE LAUROXIL,SUBMICR. 675 MG/2.4 ML IM SERS","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"J1943","type":"HCPCS"},{"code":"65757-0500-03","type":"NDC"}],"standard_charges":[{"gross_charge":5727.28,"discounted_cash":2863.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE LAUROXIL 662 MG/2.4 ML IM SERS","drug_information":{"unit":"2.4","type":"ML"},"code_information":[{"code":"J1944","type":"HCPCS"},{"code":"65757-0402-03","type":"NDC"}],"standard_charges":[{"gross_charge":5616.99,"discounted_cash":2808.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE 156 MG/ML IM SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2426","type":"HCPCS"},{"code":"50458-0563-01","type":"NDC"}],"standard_charges":[{"gross_charge":5702.51,"discounted_cash":2851.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"58468-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":5397.86,"discounted_cash":2698.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"THYROTROPIN ALFA 0.9 MG IM SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3240","type":"HCPCS"},{"code":"58468-0030-02","type":"NDC"}],"standard_charges":[{"gross_charge":5397.86,"discounted_cash":2698.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE 11.25 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5904-00","type":"NDC"}],"standard_charges":[{"gross_charge":5450.46,"discounted_cash":2725.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE 11.25 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5904-01","type":"NDC"}],"standard_charges":[{"gross_charge":5450.46,"discounted_cash":2725.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 1 MG (1,000 MCG) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7189","type":"HCPCS"},{"code":"00169-7201-01","type":"NDC"}],"standard_charges":[{"gross_charge":5713.76,"discounted_cash":2856.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTITHROMBIN III (HUMAN) 500 (+/-) UNIT IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7197","type":"HCPCS"},{"code":"13533-0606-12","type":"NDC"}],"standard_charges":[{"gross_charge":5970.73,"discounted_cash":2985.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BELINOSTAT 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9032","type":"HCPCS"},{"code":"72893-0002-01","type":"NDC"}],"standard_charges":[{"gross_charge":6244.76,"discounted_cash":3122.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELOTUZUMAB 300 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9176","type":"HCPCS"},{"code":"00003-2291-11","type":"NDC"}],"standard_charges":[{"gross_charge":5812.31,"discounted_cash":2906.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PENTOSTATIN 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9268","type":"HCPCS"},{"code":"00409-0801-01","type":"NDC"}],"standard_charges":[{"gross_charge":6159.07,"discounted_cash":3079.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARGETUXIMAB-CMKB 25 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9353","type":"HCPCS"},{"code":"74527-0022-01","type":"NDC"}],"standard_charges":[{"gross_charge":6141.13,"discounted_cash":3070.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MARGETUXIMAB-CMKB 25 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9353","type":"HCPCS"},{"code":"74527-0022-02","type":"NDC"}],"standard_charges":[{"gross_charge":6141.13,"discounted_cash":3070.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5116","type":"HCPCS"},{"code":"00069-0305-01","type":"NDC"}],"standard_charges":[{"gross_charge":5501.88,"discounted_cash":2750.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-QYYP 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5116","type":"HCPCS"},{"code":"00069-0306-01","type":"NDC"}],"standard_charges":[{"gross_charge":5501.88,"discounted_cash":2750.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-ARRX 10 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q5123","type":"HCPCS"},{"code":"55513-0326-01","type":"NDC"}],"standard_charges":[{"gross_charge":5935.93,"discounted_cash":2967.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-PBBK 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"Q5130","type":"HCPCS"},{"code":"70121-1627-01","type":"NDC"}],"standard_charges":[{"gross_charge":5415.21,"discounted_cash":2707.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGASPARGASE IM SYRINGE - PEDIATRIC","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"09999-9900-28","type":"NDC"}],"standard_charges":[{"gross_charge":7002.93,"discounted_cash":3501.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMETELSTAT  47 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"82959-0112-01","type":"NDC"}],"standard_charges":[{"gross_charge":6424.6,"discounted_cash":3212.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0840","type":"HCPCS"},{"code":"50633-0110-11","type":"NDC"}],"standard_charges":[{"gross_charge":7746.91,"discounted_cash":3873.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CROTALIDAE POLYVAL IMMUNE FAB INJ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0840","type":"HCPCS"},{"code":"50633-0110-12","type":"NDC"}],"standard_charges":[{"gross_charge":7746.91,"discounted_cash":3873.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE LAUROXIL 882 MG/3.2 ML IM SERS","drug_information":{"unit":"3.2","type":"ML"},"code_information":[{"code":"J1944","type":"HCPCS"},{"code":"65757-0403-03","type":"NDC"}],"standard_charges":[{"gross_charge":7483.64,"discounted_cash":3741.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM 250 MCG SUBQ SOLR","drug_information":{"unit":"0.25","type":"ME"},"code_information":[{"code":"J2796","type":"HCPCS"},{"code":"55513-0221-01","type":"NDC"}],"standard_charges":[{"gross_charge":6817.2,"discounted_cash":3408.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOCILIZUMAB 400 MG/20 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3262","type":"HCPCS"},{"code":"50242-0137-01","type":"NDC"}],"standard_charges":[{"gross_charge":6663.49,"discounted_cash":3331.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FACTOR XA,INACTIVATED-ZHZO 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7169","type":"HCPCS"},{"code":"00310-3200-01","type":"NDC"}],"standard_charges":[{"gross_charge":6500.0,"discounted_cash":3250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FACTOR XA,INACTIVATED-ZHZO 200 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7169","type":"HCPCS"},{"code":"00310-3200-04","type":"NDC"}],"standard_charges":[{"gross_charge":6500.0,"discounted_cash":3250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHILIC FACTOR-VWF (HUMATE-P) IV S.O.","drug_information":{"unit":"2400","type":"UN"},"code_information":[{"code":"J7187","type":"HCPCS"},{"code":"63833-0617-02","type":"NDC"}],"standard_charges":[{"gross_charge":7113.6,"discounted_cash":3556.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH (ADVATE) S.O.","drug_information":{"unit":"2000","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3045-10","type":"NDC"}],"standard_charges":[{"gross_charge":7020.0,"discounted_cash":3510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH 2,000 (+/-) UNIT IV SOLR","drug_information":{"unit":"2000","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3045-10","type":"NDC"}],"standard_charges":[{"gross_charge":7020.0,"discounted_cash":3510.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FACTOR VIII REC,FC FUSION PROT 1000 UNITS IV SOLR","drug_information":{"unit":"1106","type":"UN"},"code_information":[{"code":"J7205","type":"HCPCS"},{"code":"71104-0804-01","type":"NDC"}],"standard_charges":[{"gross_charge":7608.84,"discounted_cash":3804.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPARAGINASE (ERWINIA CHRYSAN) 10000 UNITS INJ SOLR","drug_information":{"unit":"5","type":"UN"},"code_information":[{"code":"J9019","type":"HCPCS"},{"code":"57902-0249-05","type":"NDC"}],"standard_charges":[{"gross_charge":6653.37,"discounted_cash":3326.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARATUMUMAB 20 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9145","type":"HCPCS"},{"code":"57894-0502-20","type":"NDC"}],"standard_charges":[{"gross_charge":6474.16,"discounted_cash":3237.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELOTUZUMAB 400 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9176","type":"HCPCS"},{"code":"00003-4522-11","type":"NDC"}],"standard_charges":[{"gross_charge":7749.67,"discounted_cash":3874.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 20 MG IV SOLR","drug_information":{"unit":"20","type":"ME"},"code_information":[{"code":"J9177","type":"HCPCS"},{"code":"51144-0020-01","type":"NDC"}],"standard_charges":[{"gross_charge":7303.4,"discounted_cash":3651.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GOSERELIN 10.8 MG SUBQ IMPL","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9202","type":"HCPCS"},{"code":"70720-0951-30","type":"NDC"}],"standard_charges":[{"gross_charge":7237.44,"discounted_cash":3618.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IRINOTECAN LIPOSOMAL 4.3 MG/ML IV DISP","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9205","type":"HCPCS"},{"code":"15054-0043-01","type":"NDC"}],"standard_charges":[{"gross_charge":7371.0,"discounted_cash":3685.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"J9286","type":"HCPCS"},{"code":"50242-0125-01","type":"NDC"}],"standard_charges":[{"gross_charge":6841.61,"discounted_cash":3420.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SACITUZUMAB GOVITECAN-HZIY 180 MG IV SOLR","drug_information":{"unit":"180","type":"ME"},"code_information":[{"code":"J9317","type":"HCPCS"},{"code":"55135-0132-01","type":"NDC"}],"standard_charges":[{"gross_charge":6406.46,"discounted_cash":3203.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FAM-TRASTUZUMAB DERUXTECN-NXKI 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9358","type":"HCPCS"},{"code":"65597-0406-01","type":"NDC"}],"standard_charges":[{"gross_charge":7301.77,"discounted_cash":3650.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB-AWWB 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"Q5107","type":"HCPCS"},{"code":"55513-0207-01","type":"NDC"}],"standard_charges":[{"gross_charge":6634.75,"discounted_cash":3317.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-PVVR 10 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q5119","type":"HCPCS"},{"code":"00069-0249-01","type":"NDC"}],"standard_charges":[{"gross_charge":6940.44,"discounted_cash":3470.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIVIZUMAB 100 MG/ML IM SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"90378","type":"HCPCS"},{"code":"66658-0231-01","type":"NDC"}],"standard_charges":[{"gross_charge":8938.6,"discounted_cash":4469.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SODIUM IODIDE I 131 CAPSULE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9517","type":"HCPCS"},{"code":"09999-9901-54","type":"NDC"}],"standard_charges":[{"gross_charge":7821.16,"discounted_cash":3910.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOBENGUANE SULFATE I-123 10 MCI/5 ML (370 MBQ/5 ML) IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"A9582","type":"HCPCS"},{"code":"17156-0235-01","type":"NDC"}],"standard_charges":[{"gross_charge":8902.4,"discounted_cash":4451.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IOFLUPANE I 123 5 MCI/2.5 ML (185 MBQ/2.5ML) IV SOLN","drug_information":{"unit":"2.5","type":"ML"},"code_information":[{"code":"A9584","type":"HCPCS"},{"code":"17156-0210-01","type":"NDC"}],"standard_charges":[{"gross_charge":8316.0,"discounted_cash":4158.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADALIMUMAB 40 MG/0.4 ML SUBQ PNKT","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"J0135","type":"HCPCS"},{"code":"00074-0554-02","type":"NDC"}],"standard_charges":[{"gross_charge":8684.43,"discounted_cash":4342.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADALIMUMAB 40 MG/0.8 ML SUBQ PEN KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0135","type":"HCPCS"},{"code":"00074-4339-02","type":"NDC"}],"standard_charges":[{"gross_charge":8684.43,"discounted_cash":4342.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0597","type":"HCPCS"},{"code":"63833-0835-01","type":"NDC"}],"standard_charges":[{"gross_charge":8531.23,"discounted_cash":4265.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DENOSUMAB 70 MG/ML SUBQ SOLN","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"J0897","type":"HCPCS"},{"code":"55513-0730-01","type":"NDC"}],"standard_charges":[{"gross_charge":8242.42,"discounted_cash":4121.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INCLISIRAN 284 MG/1.5 ML SUBQ SYRG","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J1306","type":"HCPCS"},{"code":"00078-1000-60","type":"NDC"}],"standard_charges":[{"gross_charge":8880.51,"discounted_cash":4440.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN,GAMMA(IGG)IFAS 10 % IV SOLN","drug_information":{"unit":"200","type":"ML"},"code_information":[{"code":"J1576","type":"HCPCS"},{"code":"68982-0822-05","type":"NDC"}],"standard_charges":[{"gross_charge":7772.96,"discounted_cash":3886.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPOLIZUMAB 100 MG SUBQ SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2182","type":"HCPCS"},{"code":"00173-0881-01","type":"NDC"}],"standard_charges":[{"gross_charge":9003.6,"discounted_cash":4501.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 10 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0790-61","type":"NDC"}],"standard_charges":[{"gross_charge":8751.92,"discounted_cash":4375.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 10 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0811-81","type":"NDC"}],"standard_charges":[{"gross_charge":8751.92,"discounted_cash":4375.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PALIPERIDONE PALMITATE 234 MG/1.5 ML IM SYRG","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J2426","type":"HCPCS"},{"code":"50458-0564-01","type":"NDC"}],"standard_charges":[{"gross_charge":8553.51,"discounted_cash":4276.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 25 MG/ML IV SOLN","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"50242-0061-01","type":"NDC"}],"standard_charges":[{"gross_charge":8564.45,"discounted_cash":4282.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEVACIZUMAB 25 MG/ML NICU INTRAVITREAL","drug_information":{"unit":"16","type":"ML"},"code_information":[{"code":"J9035","type":"HCPCS"},{"code":"50242-0061-01","type":"NDC"}],"standard_charges":[{"gross_charge":8564.45,"discounted_cash":4282.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARFILZOMIB 60 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9047","type":"HCPCS"},{"code":"76075-0101-01","type":"NDC"}],"standard_charges":[{"gross_charge":8515.47,"discounted_cash":4257.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENDAMUSTINE 25 MG/ML IV SOLN (VIVIMUSTA)","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9056","type":"HCPCS"},{"code":"71225-0120-01","type":"NDC"}],"standard_charges":[{"gross_charge":8511.71,"discounted_cash":4255.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 100 MG/10 ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9299","type":"HCPCS"},{"code":"00003-3774-12","type":"NDC"}],"standard_charges":[{"gross_charge":8270.84,"discounted_cash":4135.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIDEPSIN 10 MG/2 ML IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9319","type":"HCPCS"},{"code":"59572-0962-10","type":"NDC"}],"standard_charges":[{"gross_charge":8025.42,"discounted_cash":4012.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIDEPSIN 10 MG/2 ML IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9319","type":"HCPCS"},{"code":"59572-0984-01","type":"NDC"}],"standard_charges":[{"gross_charge":8025.42,"discounted_cash":4012.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREMELIMUMAB-ACTL 20 MG/ML IV SOLN","drug_information":{"unit":"1.25","type":"ML"},"code_information":[{"code":"J9347","type":"HCPCS"},{"code":"00310-4505-25","type":"NDC"}],"standard_charges":[{"gross_charge":8619.0,"discounted_cash":4309.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRABECTEDIN 1 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9352","type":"HCPCS"},{"code":"59676-0610-01","type":"NDC"}],"standard_charges":[{"gross_charge":8964.75,"discounted_cash":4482.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DTTB 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5112","type":"HCPCS"},{"code":"00006-5034-01","type":"NDC"}],"standard_charges":[{"gross_charge":8411.08,"discounted_cash":4205.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-DTTB 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5112","type":"HCPCS"},{"code":"00006-5034-02","type":"NDC"}],"standard_charges":[{"gross_charge":8411.08,"discounted_cash":4205.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-ABBS 10 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"Q5115","type":"HCPCS"},{"code":"63459-0104-50","type":"NDC"}],"standard_charges":[{"gross_charge":7756.19,"discounted_cash":3878.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INDIUM 111-PENTETREOTIDE 3-10 MCI/ML-MCG IV KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9572","type":"HCPCS"},{"code":"00019-9050-40","type":"NDC"}],"standard_charges":[{"gross_charge":9461.96,"discounted_cash":4730.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEZLOTOXUMAB 25 MG/ML IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J0565","type":"HCPCS"},{"code":"00006-3025-00","type":"NDC"}],"standard_charges":[{"gross_charge":9880.0,"discounted_cash":4940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BEZLOTOXUMAB 25 MG/ML IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J0565","type":"HCPCS"},{"code":"00006-3025-01","type":"NDC"}],"standard_charges":[{"gross_charge":9880.0,"discounted_cash":4940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"C1 ESTERASE INHIBITOR 500 UNIT (10 ML) IV KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0597","type":"HCPCS"},{"code":"63833-0825-02","type":"NDC"}],"standard_charges":[{"gross_charge":9043.09,"discounted_cash":4521.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CABOTEGRAVIR 600 MG/3 ML (200 MG/ML) IM SPER","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J0739","type":"HCPCS"},{"code":"49702-0264-23","type":"NDC"}],"standard_charges":[{"gross_charge":10210.34,"discounted_cash":5105.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARBEPOETIN ALFA IN POLYSORBAT 500 MCG/ML INJ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0881","type":"HCPCS"},{"code":"55513-0032-01","type":"NDC"}],"standard_charges":[{"gross_charge":9700.14,"discounted_cash":4850.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUSPATERCEPT-AAMT 25 MG SUBQ INJECTION","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0896","type":"HCPCS"},{"code":"59572-0711-01","type":"NDC"}],"standard_charges":[{"gross_charge":10278.9,"discounted_cash":5139.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANREOTIDE 120 MG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1932","type":"HCPCS"},{"code":"69097-0870-67","type":"NDC"}],"standard_charges":[{"gross_charge":10788.26,"discounted_cash":5394.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ARIPIPRAZOLE LAUROXIL 1064 MG/3.9 ML IM SERS","drug_information":{"unit":"3.9","type":"ML"},"code_information":[{"code":"J1944","type":"HCPCS"},{"code":"65757-0404-03","type":"NDC"}],"standard_charges":[{"gross_charge":9027.91,"discounted_cash":4513.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE 11.25 MG IM KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1950","type":"HCPCS"},{"code":"00074-2282-03","type":"NDC"}],"standard_charges":[{"gross_charge":9399.63,"discounted_cash":4699.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE 15 MG IM KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1950","type":"HCPCS"},{"code":"00074-2440-03","type":"NDC"}],"standard_charges":[{"gross_charge":10352.76,"discounted_cash":5176.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MEPOLIZUMAB 100 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2182","type":"HCPCS"},{"code":"00173-0892-42","type":"NDC"}],"standard_charges":[{"gross_charge":9590.96,"discounted_cash":4795.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREPROSTINIL SODIUM 10 MG/ML INJ SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J3285","type":"HCPCS"},{"code":"00703-0696-01","type":"NDC"}],"standard_charges":[{"gross_charge":10762.39,"discounted_cash":5381.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"00009-7224-01","type":"NDC"}],"standard_charges":[{"gross_charge":10516.51,"discounted_cash":5258.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML PRICK TEST","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"00009-7224-01","type":"NDC"}],"standard_charges":[{"gross_charge":10516.51,"discounted_cash":5258.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"00009-7224-02","type":"NDC"}],"standard_charges":[{"gross_charge":10516.51,"discounted_cash":5258.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LYMPHOCYTE,ANTI-THYMO IMM GLOB 50 MG/ML PRICK TEST","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J7504","type":"HCPCS"},{"code":"00009-7224-02","type":"NDC"}],"standard_charges":[{"gross_charge":10516.51,"discounted_cash":5258.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AMIVANTAMAB-VMJW 50 MG/ML IV SOLN","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"J9061","type":"HCPCS"},{"code":"57894-0501-01","type":"NDC"}],"standard_charges":[{"gross_charge":9480.51,"discounted_cash":4740.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DURVALUMAB 50 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9173","type":"HCPCS"},{"code":"00310-4611-50","type":"NDC"}],"standard_charges":[{"gross_charge":10732.57,"discounted_cash":5366.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOGAMULIZUMAB-KPKC 4 MG/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9204","type":"HCPCS"},{"code":"42747-0761-01","type":"NDC"}],"standard_charges":[{"gross_charge":10001.81,"discounted_cash":5000.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ  30 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9309","type":"HCPCS"},{"code":"50242-0103-01","type":"NDC"}],"standard_charges":[{"gross_charge":10067.23,"discounted_cash":5033.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"50242-0088-01","type":"NDC"}],"standard_charges":[{"gross_charge":10219.75,"discounted_cash":5109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-PKRB 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5113","type":"HCPCS"},{"code":"63459-0305-47","type":"NDC"}],"standard_charges":[{"gross_charge":10006.0,"discounted_cash":5003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-PKRB 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5113","type":"HCPCS"},{"code":"63459-0307-41","type":"NDC"}],"standard_charges":[{"gross_charge":10006.0,"discounted_cash":5003.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-ANNS 420 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"Q5117","type":"HCPCS"},{"code":"55513-0164-01","type":"NDC"}],"standard_charges":[{"gross_charge":9509.19,"discounted_cash":4754.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM-BMEZ 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"Q5120","type":"HCPCS"},{"code":"61314-0866-01","type":"NDC"}],"standard_charges":[{"gross_charge":10002.26,"discounted_cash":5001.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CABOTEGRAVIR-RILPIVIRINE 400 MG/2 ML- 600 MG/2 ML IM SPER","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J0741","type":"HCPCS"},{"code":"49702-0253-15","type":"NDC"}],"standard_charges":[{"gross_charge":11481.03,"discounted_cash":5740.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"50633-0120-11","type":"NDC"}],"standard_charges":[{"gross_charge":11586.46,"discounted_cash":5793.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DIGOXIN IMMUNE FAB 40 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1162","type":"HCPCS"},{"code":"50633-0121-11","type":"NDC"}],"standard_charges":[{"gross_charge":11586.46,"discounted_cash":5793.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMMUNE GLOBULIN,GAMMA(IGG)IFAS 10 % IV SOLN","drug_information":{"unit":"300","type":"ML"},"code_information":[{"code":"J1576","type":"HCPCS"},{"code":"68982-0822-06","type":"NDC"}],"standard_charges":[{"gross_charge":11659.44,"discounted_cash":5829.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANREOTIDE 120 MG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J1930","type":"HCPCS"},{"code":"15054-1120-04","type":"NDC"}],"standard_charges":[{"gross_charge":10788.26,"discounted_cash":5394.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE (3 MONTH) 11.25 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J1950","type":"HCPCS"},{"code":"00074-3663-03","type":"NDC"}],"standard_charges":[{"gross_charge":12911.5,"discounted_cash":6455.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 20 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0797-61","type":"NDC"}],"standard_charges":[{"gross_charge":11466.5,"discounted_cash":5733.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 20 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0818-81","type":"NDC"}],"standard_charges":[{"gross_charge":11466.5,"discounted_cash":5733.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEZEPELUMAB-EKKO 210 MG/1.91 ML (110 MG/ML) SUBQ SYRG","drug_information":{"unit":"1.91","type":"ML"},"code_information":[{"code":"J2356","type":"HCPCS"},{"code":"55513-0112-01","type":"NDC"}],"standard_charges":[{"gross_charge":10817.28,"discounted_cash":5408.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYRG","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J2506","type":"HCPCS"},{"code":"55513-0190-01","type":"NDC"}],"standard_charges":[{"gross_charge":10788.7,"discounted_cash":5394.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGFILGRASTIM 6 MG/0.6 ML SUBQ SYIN","drug_information":{"unit":"0.6","type":"ML"},"code_information":[{"code":"J2506","type":"HCPCS"},{"code":"55513-0192-01","type":"NDC"}],"standard_charges":[{"gross_charge":10788.7,"discounted_cash":5394.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE  50 MG IV SOLR","drug_information":{"unit":"50","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0044-13","type":"NDC"}],"standard_charges":[{"gross_charge":11040.12,"discounted_cash":5520.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE 22.5 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5906-00","type":"NDC"}],"standard_charges":[{"gross_charge":10900.89,"discounted_cash":5450.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRIPTORELIN PAMOATE 22.5 MG IM SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3315","type":"HCPCS"},{"code":"74676-5906-01","type":"NDC"}],"standard_charges":[{"gross_charge":10900.89,"discounted_cash":5450.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IDARUCIZUMAB 2.5 GRAM/50 ML IV SOLN","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"00597-0197-05","type":"NDC"}],"standard_charges":[{"gross_charge":12692.24,"discounted_cash":6346.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 2 MG (2,000 MCG) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7189","type":"HCPCS"},{"code":"00169-7202-01","type":"NDC"}],"standard_charges":[{"gross_charge":11427.52,"discounted_cash":5713.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH (ADVATE) S.O.","drug_information":{"unit":"3115","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3046-10","type":"NDC"}],"standard_charges":[{"gross_charge":10933.65,"discounted_cash":5466.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANTIHEMOPHIL FVIII,FULL LENGTH 3,000 (+/-) UNIT IV SOLR","drug_information":{"unit":"3115","type":"F2"},"code_information":[{"code":"J7192","type":"HCPCS"},{"code":"00944-3046-10","type":"NDC"}],"standard_charges":[{"gross_charge":10933.65,"discounted_cash":5466.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FACTOR VIII REC,FC FUSION PROT 1500 UNITS IV SOLR","drug_information":{"unit":"1641","type":"UN"},"code_information":[{"code":"J7205","type":"HCPCS"},{"code":"71104-0805-01","type":"NDC"}],"standard_charges":[{"gross_charge":11289.43,"discounted_cash":5644.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPARAGINASE ERWINIA-RYWN 10 MG/0.5 ML IM SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J9021","type":"HCPCS"},{"code":"68727-0900-01","type":"NDC"}],"standard_charges":[{"gross_charge":13338.0,"discounted_cash":6669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPARAGINASE ERWINIA-RYWN 10 MG/0.5 ML IM SOLN - PEDIATRIC","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J9021","type":"HCPCS"},{"code":"68727-0900-01","type":"NDC"}],"standard_charges":[{"gross_charge":13338.0,"discounted_cash":6669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPARAGINASE ERWINIA-RYWN 10 MG/0.5 ML IM SOLN","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J9021","type":"HCPCS"},{"code":"68727-0900-03","type":"NDC"}],"standard_charges":[{"gross_charge":13338.0,"discounted_cash":6669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ASPARAGINASE ERWINIA-RYWN 10 MG/0.5 ML IM SOLN - PEDIATRIC","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J9021","type":"HCPCS"},{"code":"68727-0900-03","type":"NDC"}],"standard_charges":[{"gross_charge":13338.0,"discounted_cash":6669.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BLINATUMOMAB 35 MCG IV KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9039","type":"HCPCS"},{"code":"55513-0160-01","type":"NDC"}],"standard_charges":[{"gross_charge":13484.44,"discounted_cash":6742.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ENFORTUMAB VEDOTIN-EJFV 30 MG IV SOLR","drug_information":{"unit":"30","type":"ME"},"code_information":[{"code":"J9177","type":"HCPCS"},{"code":"51144-0030-01","type":"NDC"}],"standard_charges":[{"gross_charge":10955.1,"discounted_cash":5477.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NECITUMUMAB 800 MG/50 ML (16 MG/ML) IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9295","type":"HCPCS"},{"code":"00002-7716-01","type":"NDC"}],"standard_charges":[{"gross_charge":11257.35,"discounted_cash":5628.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRALATREXATE 20 MG/ML (1 ML) IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9307","type":"HCPCS"},{"code":"65219-0550-01","type":"NDC"}],"standard_charges":[{"gross_charge":12068.42,"discounted_cash":6034.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB 10 MG/ML IV CONC","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"50242-0053-06","type":"NDC"}],"standard_charges":[{"gross_charge":12213.76,"discounted_cash":6106.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB 10 MG/ML IV CONC FOR DESENSITIZATION","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9312","type":"HCPCS"},{"code":"50242-0053-06","type":"NDC"}],"standard_charges":[{"gross_charge":12213.76,"discounted_cash":6106.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TRASTUZUMAB-HYALURONIDASE-OYSK 600 MG-10,000 UNIT/5 ML SUBQ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9356","type":"HCPCS"},{"code":"50242-0077-01","type":"NDC"}],"standard_charges":[{"gross_charge":12308.79,"discounted_cash":6154.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADALIMUMAB 80 MG/0.8 ML SUBQ PNKT","drug_information":{"unit":"2","type":"UN"},"code_information":[{"code":"J0135","type":"HCPCS"},{"code":"00074-0124-02","type":"NDC"}],"standard_charges":[{"gross_charge":17368.9,"discounted_cash":8684.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ANIFROLUMAB-FNIA 300 MG/2 ML (150 MG/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J0491","type":"HCPCS"},{"code":"00310-3040-00","type":"NDC"}],"standard_charges":[{"gross_charge":13596.37,"discounted_cash":6798.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BENRALIZUMAB 30 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0517","type":"HCPCS"},{"code":"00310-1730-30","type":"NDC"}],"standard_charges":[{"gross_charge":14759.55,"discounted_cash":7379.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBQ KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0717","type":"HCPCS"},{"code":"50474-0700-62","type":"NDC"}],"standard_charges":[{"gross_charge":14869.9,"discounted_cash":7434.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CABOTEGRAVIR-RILPIVIRINE 600 MG/3 ML- 900 MG/3 ML IM SPER","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"J0741","type":"HCPCS"},{"code":"49702-0240-15","type":"NDC"}],"standard_charges":[{"gross_charge":17221.52,"discounted_cash":8610.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECULIZUMAB 300 MG/30 ML IV SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J1300","type":"HCPCS"},{"code":"25682-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":16959.78,"discounted_cash":8479.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAVULIZUMAB-CWVZ 100 MG/ML IV SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1303","type":"HCPCS"},{"code":"25682-0025-01","type":"NDC"}],"standard_charges":[{"gross_charge":16650.41,"discounted_cash":8325.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LANREOTIDE 60 MG/0.2 ML SUBQ SYRG","drug_information":{"unit":"0.2","type":"ML"},"code_information":[{"code":"J1930","type":"HCPCS"},{"code":"15054-1060-04","type":"NDC"}],"standard_charges":[{"gross_charge":15907.95,"discounted_cash":7953.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ZICONOTIDE  25 MCG/ML IT SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J2278","type":"HCPCS"},{"code":"70720-0723-10","type":"NDC"}],"standard_charges":[{"gross_charge":13736.48,"discounted_cash":6868.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 30 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0804-61","type":"NDC"}],"standard_charges":[{"gross_charge":17170.17,"discounted_cash":8585.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCTREOTIDE,MICROSPHERES 30 MG IM SERR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J2353","type":"HCPCS"},{"code":"00078-0825-81","type":"NDC"}],"standard_charges":[{"gross_charge":17170.17,"discounted_cash":8585.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FACTOR VIII REC,FC FUSION PROT 2000 UNITS IV SOLR","drug_information":{"unit":"2000","type":"UN"},"code_information":[{"code":"J7205","type":"HCPCS"},{"code":"71104-0806-01","type":"NDC"}],"standard_charges":[{"gross_charge":13759.2,"discounted_cash":6879.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COPANLISIB 60 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9057","type":"HCPCS"},{"code":"50419-0385-01","type":"NDC"}],"standard_charges":[{"gross_charge":13659.36,"discounted_cash":6829.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MIRVETUXIMAB SORAVTANSINE-GYNX 5 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9063","type":"HCPCS"},{"code":"72903-0853-01","type":"NDC"}],"standard_charges":[{"gross_charge":16866.62,"discounted_cash":8433.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE (3 MONTH) 22.5 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"00074-3346-03","type":"NDC"}],"standard_charges":[{"gross_charge":15385.89,"discounted_cash":7692.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEMBROLIZUMAB 25 MG/ML IV SOLN","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9271","type":"HCPCS"},{"code":"00006-3026-04","type":"NDC"}],"standard_charges":[{"gross_charge":14738.57,"discounted_cash":7369.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PANITUMUMAB 400 MG/20 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9303","type":"HCPCS"},{"code":"55513-0956-01","type":"NDC"}],"standard_charges":[{"gross_charge":17314.18,"discounted_cash":8657.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERTUZUMAB 420 MG/14 ML (30 MG/ML) IV SOLN","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"J9306","type":"HCPCS"},{"code":"50242-0145-01","type":"NDC"}],"standard_charges":[{"gross_charge":15838.34,"discounted_cash":7919.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERTUZUMAB 420 MG/14 ML FOR DESENSITIZATION","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"J9306","type":"HCPCS"},{"code":"50242-0145-01","type":"NDC"}],"standard_charges":[{"gross_charge":15838.34,"discounted_cash":7919.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-HYALURONIDASE,HUMAN 1400 MG/11.7 ML (120 MG/ML) SUBQ SOLN","drug_information":{"unit":"11.7","type":"ML"},"code_information":[{"code":"J9311","type":"HCPCS"},{"code":"50242-0108-01","type":"NDC"}],"standard_charges":[{"gross_charge":17099.12,"discounted_cash":8549.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EFGARTIGIMOD ALFA-FCAB 20 MG/ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9332","type":"HCPCS"},{"code":"73475-3041-05","type":"NDC"}],"standard_charges":[{"gross_charge":16094.99,"discounted_cash":8047.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROZANOLIXIZUMAB-NOLI 140 MG/ML SUBQ SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9333","type":"HCPCS"},{"code":"50474-0980-79","type":"NDC"}],"standard_charges":[{"gross_charge":15745.73,"discounted_cash":7872.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ADO-TRASTUZUMAB EMTANSINE 160 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9354","type":"HCPCS"},{"code":"50242-0087-01","type":"NDC"}],"standard_charges":[{"gross_charge":16384.26,"discounted_cash":8192.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"STRONTIUM-89 CHLORIDE 1 MILLICURIE/ML IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9600","type":"HCPCS"},{"code":"17156-0524-01","type":"NDC"}],"standard_charges":[{"gross_charge":18118.99,"discounted_cash":9059.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"AGALSIDASE BETA 35 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0180","type":"HCPCS"},{"code":"58468-0040-01","type":"NDC"}],"standard_charges":[{"gross_charge":17921.67,"discounted_cash":8960.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBQ SOLN","drug_information":{"unit":"1.1","type":"ML"},"code_information":[{"code":"J1323","type":"HCPCS"},{"code":"00069-2522-02","type":"NDC"}],"standard_charges":[{"gross_charge":19644.77,"discounted_cash":9822.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NATALIZUMAB 300 MG/15 ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J2323","type":"HCPCS"},{"code":"64406-0008-01","type":"NDC"}],"standard_charges":[{"gross_charge":21344.31,"discounted_cash":10672.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROMIPLOSTIM 500 MCG SUBQ SOLR","drug_information":{"unit":"0.5","type":"ME"},"code_information":[{"code":"J2796","type":"HCPCS"},{"code":"55513-0222-01","type":"NDC"}],"standard_charges":[{"gross_charge":20976.0,"discounted_cash":10488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 100 MG IV SOLR","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0085-27","type":"NDC"}],"standard_charges":[{"gross_charge":22080.24,"discounted_cash":11040.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE INFUSION FOR **PULMONARY EMBOLUS** FOR COMMUNITY HOSPITAL EDS","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0085-27","type":"NDC"}],"standard_charges":[{"gross_charge":22080.24,"discounted_cash":11040.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TALQUETAMAB-TGVS 40 MG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3055","type":"HCPCS"},{"code":"57894-0470-01","type":"NDC"}],"standard_charges":[{"gross_charge":20371.32,"discounted_cash":10185.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENECTEPLASE FOR STROKE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"09999-9996-02","type":"NDC"}],"standard_charges":[{"gross_charge":18961.75,"discounted_cash":9480.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENECTEPLASE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"50242-0037-06","type":"NDC"}],"standard_charges":[{"gross_charge":18961.75,"discounted_cash":9480.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TENECTEPLASE 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3101","type":"HCPCS"},{"code":"50242-0120-47","type":"NDC"}],"standard_charges":[{"gross_charge":18961.75,"discounted_cash":9480.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"VEDOLIZUMAB 300 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3380","type":"HCPCS"},{"code":"64764-0300-20","type":"NDC"}],"standard_charges":[{"gross_charge":22533.11,"discounted_cash":11266.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ROPEGINTERFERON ALFA-2B-NJFT 500 MCG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3590","type":"HCPCS"},{"code":"73536-0500-01","type":"NDC"}],"standard_charges":[{"gross_charge":18168.8,"discounted_cash":9084.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATEZOLIZUMAB 840 MG/14 ML (60 MG/ML) IV SOLN","drug_information":{"unit":"14","type":"ML"},"code_information":[{"code":"J9022","type":"HCPCS"},{"code":"50242-0918-01","type":"NDC"}],"standard_charges":[{"gross_charge":18556.4,"discounted_cash":9278.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE (4 MONTH) 30 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"00074-3683-03","type":"NDC"}],"standard_charges":[{"gross_charge":20514.55,"discounted_cash":10257.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LURBINECTEDIN 4 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9223","type":"HCPCS"},{"code":"68727-0712-01","type":"NDC"}],"standard_charges":[{"gross_charge":20878.0,"discounted_cash":10439.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TISOTUMAB VEDOTIN-TFTV 40 MG IV SOLR","drug_information":{"unit":"4","type":"ML"},"code_information":[{"code":"J9273","type":"HCPCS"},{"code":"51144-0003-01","type":"NDC"}],"standard_charges":[{"gross_charge":17825.6,"discounted_cash":8912.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB 240 MG/24 ML IV SOLN","drug_information":{"unit":"24","type":"ML"},"code_information":[{"code":"J9299","type":"HCPCS"},{"code":"00003-3734-13","type":"NDC"}],"standard_charges":[{"gross_charge":19850.07,"discounted_cash":9925.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OBINUTUZUMAB 900 MG/250 ML  INFUSION - CMP","drug_information":{"unit":"306","type":"ML"},"code_information":[{"code":"J9301","type":"HCPCS"},{"code":"09999-9996-01","type":"NDC"}],"standard_charges":[{"gross_charge":21428.7,"discounted_cash":10714.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OBINUTUZUMAB 1000 MG/40 ML IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J9301","type":"HCPCS"},{"code":"50242-0070-01","type":"NDC"}],"standard_charges":[{"gross_charge":21428.79,"discounted_cash":10714.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OBINUTUZUMAB FOR DESENSITIZATION 1000 MG/40 ML IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J9301","type":"HCPCS"},{"code":"50242-0070-01","type":"NDC"}],"standard_charges":[{"gross_charge":21428.79,"discounted_cash":10714.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRALATREXATE CHEMO SYRINGE","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J9307","type":"HCPCS"},{"code":"48818-0001-01","type":"NDC"}],"standard_charges":[{"gross_charge":17647.56,"discounted_cash":8823.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAMUCIRUMAB 10 MG/ML IV SOLN","drug_information":{"unit":"50","type":"ML"},"code_information":[{"code":"J9308","type":"HCPCS"},{"code":"00002-7678-01","type":"NDC"}],"standard_charges":[{"gross_charge":18938.27,"discounted_cash":9469.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RITUXIMAB-HYALURONIDASE,HUMAN 1600 MG/13.4 ML (120 MG/ML) SUBQ SOLN","drug_information":{"unit":"13.4","type":"ML"},"code_information":[{"code":"J9311","type":"HCPCS"},{"code":"50242-0109-01","type":"NDC"}],"standard_charges":[{"gross_charge":19600.16,"discounted_cash":9800.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIROLIMUS-PROTEIN BOUND 100 MG IV SUSR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9331","type":"HCPCS"},{"code":"80803-0153-50","type":"NDC"}],"standard_charges":[{"gross_charge":19850.9,"discounted_cash":9925.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TECLISTAMAB-CQYV 90 MG/ML SUBQ SOLN","drug_information":{"unit":"1.7","type":"ML"},"code_information":[{"code":"J9380","type":"HCPCS"},{"code":"57894-0450-01","type":"NDC"}],"standard_charges":[{"gross_charge":18359.05,"discounted_cash":9179.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RADIUM RA 223 DICHLORIDE 1,100 KBQ/ML(30 MICROCURIE/ML) IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9606","type":"HCPCS"},{"code":"50419-0208-01","type":"NDC"}],"standard_charges":[{"gross_charge":27258.92,"discounted_cash":13629.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPLACIZUMAB-YHDP 11 MG INJ KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9047","type":"HCPCS"},{"code":"58468-0225-01","type":"NDC"}],"standard_charges":[{"gross_charge":23143.54,"discounted_cash":11571.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CAPLACIZUMAB-YHDP 11 MG SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9047","type":"HCPCS"},{"code":"58468-0225-01","type":"NDC"}],"standard_charges":[{"gross_charge":23143.54,"discounted_cash":11571.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IMETELSTAT 188 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9399","type":"HCPCS"},{"code":"82959-0111-01","type":"NDC"}],"standard_charges":[{"gross_charge":25698.4,"discounted_cash":12849.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FECAL MICROBIOTA, LIVE-JSLM 150 ML RECT ENEM","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1440","type":"HCPCS"},{"code":"55566-9800-00","type":"NDC"}],"standard_charges":[{"gross_charge":23751.0,"discounted_cash":11875.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"FECAL MICROBIOTA, LIVE-JSLM 150 ML RECT ENEM","drug_information":{"unit":"150","type":"ML"},"code_information":[{"code":"J1440","type":"HCPCS"},{"code":"55566-9800-02","type":"NDC"}],"standard_charges":[{"gross_charge":23751.0,"discounted_cash":11875.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEMIN 350 MG IV SOLR","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"J1640","type":"HCPCS"},{"code":"55292-0702-54","type":"NDC"}],"standard_charges":[{"gross_charge":27805.96,"discounted_cash":13902.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"HEMIN 350 MG IV SOLR","drug_information":{"unit":"350","type":"ME"},"code_information":[{"code":"J1640","type":"HCPCS"},{"code":"55292-0702-55","type":"NDC"}],"standard_charges":[{"gross_charge":27805.96,"discounted_cash":13902.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LENACAPAVIR 309 MG/ML SUBQ SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J1961","type":"HCPCS"},{"code":"61958-3002-01","type":"NDC"}],"standard_charges":[{"gross_charge":25350.0,"discounted_cash":12675.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LENACAPAVIR 309 MG/ML SUBQ SOLN","drug_information":{"unit":"1.5","type":"ML"},"code_information":[{"code":"J1961","type":"HCPCS"},{"code":"61958-3004-01","type":"NDC"}],"standard_charges":[{"gross_charge":25350.0,"discounted_cash":12675.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RISANKIZUMAB-RZAA  60 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2327","type":"HCPCS"},{"code":"00074-5015-01","type":"NDC"}],"standard_charges":[{"gross_charge":24514.21,"discounted_cash":12257.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"UBLITUXIMAB-XIIY 25 MG/ML IV SOLN","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"J2329","type":"HCPCS"},{"code":"73150-0150-06","type":"NDC"}],"standard_charges":[{"gross_charge":27228.51,"discounted_cash":13614.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TORIPALIMAB-TPZI 240 MG/6 ML (40 MG/ML) IV SOLN","drug_information":{"unit":"6","type":"ML"},"code_information":[{"code":"J3263","type":"HCPCS"},{"code":"70114-0340-01","type":"NDC"}],"standard_charges":[{"gross_charge":23581.67,"discounted_cash":11790.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"COAGULATION FACTOR VIIA RECOMB 5 MG (5,000 MCG) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J7189","type":"HCPCS"},{"code":"00169-7205-01","type":"NDC"}],"standard_charges":[{"gross_charge":28568.8,"discounted_cash":14284.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ATEZOLIZUMAB 1,200 MG/20 ML (60 MG/ML) IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9022","type":"HCPCS"},{"code":"50242-0917-01","type":"NDC"}],"standard_charges":[{"gross_charge":28402.66,"discounted_cash":14201.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"BRENTUXIMAB VEDOTIN 50 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9042","type":"HCPCS"},{"code":"51144-0050-01","type":"NDC"}],"standard_charges":[{"gross_charge":30529.2,"discounted_cash":15264.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CEMIPLIMAB-RWLC 50 MG/ML IV SOLN","drug_information":{"unit":"7","type":"ML"},"code_information":[{"code":"J9119","type":"HCPCS"},{"code":"61755-0008-01","type":"NDC"}],"standard_charges":[{"gross_charge":26774.33,"discounted_cash":13387.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DARATUMUMAB-HYALURONIDASE-FIHJ 1,800 MG-30,000 UNIT/15 ML SUBQ SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9144","type":"HCPCS"},{"code":"57894-0503-01","type":"NDC"}],"standard_charges":[{"gross_charge":23078.1,"discounted_cash":11539.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNORUBICIN-CYTARABINE LIPOS 44-100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"68727-0745-01","type":"NDC"}],"standard_charges":[{"gross_charge":27509.2,"discounted_cash":13754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DAUNORUBICIN-CYTARABINE LIPOS 44-100 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9153","type":"HCPCS"},{"code":"68727-0745-02","type":"NDC"}],"standard_charges":[{"gross_charge":27509.2,"discounted_cash":13754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GEMTUZUMAB OZOGAMICIN 4.5 MG (1 MG/ML INITIAL CONC) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9203","type":"HCPCS"},{"code":"00008-4510-01","type":"NDC"}],"standard_charges":[{"gross_charge":25731.06,"discounted_cash":12865.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LEUPROLIDE ACETATE (6 MONTH) 45 MG IM SYKT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9217","type":"HCPCS"},{"code":"00074-3473-03","type":"NDC"}],"standard_charges":[{"gross_charge":30772.28,"discounted_cash":15386.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPILIMUMAB 50 MG/10 ML (5 MG/ML) IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9228","type":"HCPCS"},{"code":"00003-2327-11","type":"NDC"}],"standard_charges":[{"gross_charge":22628.17,"discounted_cash":11314.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"DOSTARLIMAB-GXLY 50 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9272","type":"HCPCS"},{"code":"00173-0898-03","type":"NDC"}],"standard_charges":[{"gross_charge":30064.12,"discounted_cash":15032.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLOFITAMAB-GXBM 1 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9286","type":"HCPCS"},{"code":"50242-0127-01","type":"NDC"}],"standard_charges":[{"gross_charge":27366.41,"discounted_cash":13683.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERTUZUMAB-TRASTUZUMAB-HY-ZZXF 600 MG-600 MG- 20000 UNIT/10ML SUBQ SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J9316","type":"HCPCS"},{"code":"50242-0260-01","type":"NDC"}],"standard_charges":[{"gross_charge":23082.34,"discounted_cash":11541.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"KIT FOR YTTRIUM-90 81 MILICURIES/5 ML","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C2616","type":"HCPCS"},{"code":"09999-9418-15","type":"NDC"}],"standard_charges":[{"gross_charge":47697.0,"discounted_cash":23848.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TARLATAMAB-DLLE 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9170","type":"HCPCS"},{"code":"55513-0077-01","type":"NDC"}],"standard_charges":[{"gross_charge":39000.0,"discounted_cash":19500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CANAKINUMAB (PF) 150 MG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0638","type":"HCPCS"},{"code":"00078-0734-61","type":"NDC"}],"standard_charges":[{"gross_charge":50655.15,"discounted_cash":25327.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LUSPATERCEPT-AAMT 75 MG SQ INJECTION","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J0896","type":"HCPCS"},{"code":"59572-0775-01","type":"NDC"}],"standard_charges":[{"gross_charge":30898.25,"discounted_cash":15449.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ECALLANTIDE 10 MG/ML (1 ML) SUBQ SOLN","drug_information":{"unit":"3","type":"ML"},"code_information":[{"code":"J1290","type":"HCPCS"},{"code":"47783-0101-01","type":"NDC"}],"standard_charges":[{"gross_charge":43214.87,"discounted_cash":21607.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TOFERSEN 100 MG/15 ML (6.7 MG/ML) IT SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J1304","type":"HCPCS"},{"code":"64406-0109-01","type":"NDC"}],"standard_charges":[{"gross_charge":36998.02,"discounted_cash":18499.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ELRANATAMAB-BCMM 40 MG/ML SUBQ SOLN","drug_information":{"unit":"1.9","type":"ML"},"code_information":[{"code":"J1323","type":"HCPCS"},{"code":"00069-4494-02","type":"NDC"}],"standard_charges":[{"gross_charge":33931.88,"discounted_cash":16965.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GUSELKUMAB 100 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J1628","type":"HCPCS"},{"code":"57894-0640-01","type":"NDC"}],"standard_charges":[{"gross_charge":33605.76,"discounted_cash":16802.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE 100 MG IV SOLR (BOLUS FOR ED)","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0085-27","type":"NDC"}],"standard_charges":[{"gross_charge":32271.12,"discounted_cash":16135.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE BOLUS FOR **STROKE** FOR COMMUNITY HOSPITAL EDS","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0085-27","type":"NDC"}],"standard_charges":[{"gross_charge":32271.12,"discounted_cash":16135.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"ALTEPLASE INFUSION FOR **STROKE** FOR COMMUNITY HOSPITAL EDS","drug_information":{"unit":"100","type":"ME"},"code_information":[{"code":"J2997","type":"HCPCS"},{"code":"50242-0085-27","type":"NDC"}],"standard_charges":[{"gross_charge":32271.12,"discounted_cash":16135.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEPROTUMUMAB-TRBW 500 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J3241","type":"HCPCS"},{"code":"75987-0130-15","type":"NDC"}],"standard_charges":[{"gross_charge":44245.82,"discounted_cash":22122.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"USTEKINUMAB 45 MG/0.5 ML SUBQ SYRG","drug_information":{"unit":"0.5","type":"ML"},"code_information":[{"code":"J3357","type":"HCPCS"},{"code":"57894-0060-03","type":"NDC"}],"standard_charges":[{"gross_charge":34928.87,"discounted_cash":17464.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CABAZITAXEL 10 MG/ML (FIRST DILUTION) IV SOLN","drug_information":{"unit":"60","type":"ME"},"code_information":[{"code":"J9043","type":"HCPCS"},{"code":"00024-5824-11","type":"NDC"}],"standard_charges":[{"gross_charge":36781.06,"discounted_cash":18390.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGASPARGASE IM SYRINGE","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9266","type":"HCPCS"},{"code":"54482-0301-01","type":"NDC"}],"standard_charges":[{"gross_charge":35014.65,"discounted_cash":17507.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGASPARGASE 750 UNITS/ML INJ SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9266","type":"HCPCS"},{"code":"72694-0954-01","type":"NDC"}],"standard_charges":[{"gross_charge":48363.59,"discounted_cash":24181.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"NIVOLUMAB-RELATLIMAB-RMBW 240-80 MG/20 ML IV SOLN","drug_information":{"unit":"20","type":"ML"},"code_information":[{"code":"J9298","type":"HCPCS"},{"code":"00003-7125-11","type":"NDC"}],"standard_charges":[{"gross_charge":38540.12,"discounted_cash":19270.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PRALATREXATE 40 MG/2 ML (20 MG/ML) IV SOLN","drug_information":{"unit":"2","type":"ML"},"code_information":[{"code":"J9307","type":"HCPCS"},{"code":"72893-0005-01","type":"NDC"}],"standard_charges":[{"gross_charge":37038.3,"discounted_cash":18519.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"POLATUZUMAB VEDOTIN-PIIQ 140 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9309","type":"HCPCS"},{"code":"50242-0105-01","type":"NDC"}],"standard_charges":[{"gross_charge":47027.24,"discounted_cash":23513.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PERTUZUMAB-TRASTUZUMAB-HY-ZZXF 1,200 MG-600MG- 30000 UNIT/15ML SUBQ SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9316","type":"HCPCS"},{"code":"50242-0245-01","type":"NDC"}],"standard_charges":[{"gross_charge":34624.87,"discounted_cash":17312.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"EPCORITAMAB-BYSP 48 MG/0.8 ML SUBQ SOLN","drug_information":{"unit":"0.8","type":"ML"},"code_information":[{"code":"J9321","type":"HCPCS"},{"code":"82705-0010-01","type":"NDC"}],"standard_charges":[{"gross_charge":41184.94,"discounted_cash":20592.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MOSUNETUZUMAB-AXGB 1 MG/ML IV SOLN","drug_information":{"unit":"30","type":"ML"},"code_information":[{"code":"J9350","type":"HCPCS"},{"code":"50242-0142-01","type":"NDC"}],"standard_charges":[{"gross_charge":47737.02,"discounted_cash":23868.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TEPLIZUMAB-MZWV 1 MG/ML IV SOLN","drug_information":{"unit":"2","type":"ME"},"code_information":[{"code":"J9381","type":"HCPCS"},{"code":"73650-0316-14","type":"NDC"}],"standard_charges":[{"gross_charge":36010.0,"discounted_cash":18005.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LU-177 VIPIVOTIDE TETRAXETAN 27 MCI/ML (1,000 MBQ/ML) IV SOLN","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"A9607","type":"HCPCS"},{"code":"69488-0010-61","type":"NDC"}],"standard_charges":[{"gross_charge":115745.76,"discounted_cash":57872.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GLUCARPIDASE (VORAXAZE) IV SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"C9293","type":"HCPCS"},{"code":"50633-0210-11","type":"NDC"}],"standard_charges":[{"gross_charge":107052.4,"discounted_cash":53526.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"GIVOSIRAN 189 MG/ML SUBQ SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J0223","type":"HCPCS"},{"code":"71336-1001-01","type":"NDC"}],"standard_charges":[{"gross_charge":107575.0,"discounted_cash":53787.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CORTICOTROPIN 80 UNITS/ML INJ GEL","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J0801","type":"HCPCS"},{"code":"63004-8710-02","type":"NDC"}],"standard_charges":[{"gross_charge":60499.4,"discounted_cash":30249.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"RAVULIZUMAB-CWVZ 100 MG/ML IV SOLN","drug_information":{"unit":"11","type":"ML"},"code_information":[{"code":"J1303","type":"HCPCS"},{"code":"25682-0028-01","type":"NDC"}],"standard_charges":[{"gross_charge":61051.48,"discounted_cash":30525.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SPESOLIMAB-SBZO  60 MG/ML IV SOLN","drug_information":{"unit":"450","type":"ME"},"code_information":[{"code":"J1747","type":"HCPCS"},{"code":"00597-0035-10","type":"NDC"}],"standard_charges":[{"gross_charge":67802.67,"discounted_cash":33901.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"OCRELIZUMAB 30 MG/ML IV SOLN","drug_information":{"unit":"10","type":"ML"},"code_information":[{"code":"J2350","type":"HCPCS"},{"code":"50242-0150-01","type":"NDC"}],"standard_charges":[{"gross_charge":51257.39,"discounted_cash":25628.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PEGLOTICASE 8 MG/ML IV SOLN","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J2507","type":"HCPCS"},{"code":"75987-0080-10","type":"NDC"}],"standard_charges":[{"gross_charge":72697.46,"discounted_cash":36348.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"USTEKINUMAB 90 MG/ML SUBQ SYRG","drug_information":{"unit":"1","type":"ML"},"code_information":[{"code":"J3357","type":"HCPCS"},{"code":"57894-0061-03","type":"NDC"}],"standard_charges":[{"gross_charge":69857.74,"discounted_cash":34928.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CALASPARGASE PEGOL-MKNL 750 UNITS/ML IV SOLN","drug_information":{"unit":"5","type":"ML"},"code_information":[{"code":"J9118","type":"HCPCS"},{"code":"72694-0515-01","type":"NDC"}],"standard_charges":[{"gross_charge":67041.0,"discounted_cash":33520.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"IPILIMUMAB 200 MG/40 ML (5 MG/ML) IV SOLN","drug_information":{"unit":"40","type":"ML"},"code_information":[{"code":"J9228","type":"HCPCS"},{"code":"00003-2328-22","type":"NDC"}],"standard_charges":[{"gross_charge":90512.45,"discounted_cash":45256.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"INOTUZUMAB OZOGAMICIN 0.9 MG (0.25 MG/ML INITIAL) IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9229","type":"HCPCS"},{"code":"00008-0100-01","type":"NDC"}],"standard_charges":[{"gross_charge":65134.2,"discounted_cash":32567.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TAGRAXOFUSP-ERZS 1000 MCG/10 ML IV DILUTION","drug_information":{"unit":"1","type":"ME"},"code_information":[{"code":"J9269","type":"HCPCS"},{"code":"72187-0401-01","type":"NDC"}],"standard_charges":[{"gross_charge":83587.4,"discounted_cash":41793.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN (JELMYTO) URETERAL GEL CNR","drug_information":{"unit":"80","type":"ME"},"code_information":[{"code":"J9281","type":"HCPCS"},{"code":"09999-9998-10","type":"NDC"}],"standard_charges":[{"gross_charge":55577.6,"discounted_cash":27788.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"MITOMYCIN (JELMYTO) URETERAL GEL KIT","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9281","type":"HCPCS"},{"code":"72493-0103-03","type":"NDC"}],"standard_charges":[{"gross_charge":55577.6,"discounted_cash":27788.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"TREMELIMUMAB-ACTL 20 MG/ML IV SOLN","drug_information":{"unit":"15","type":"ML"},"code_information":[{"code":"J9347","type":"HCPCS"},{"code":"00310-4535-30","type":"NDC"}],"standard_charges":[{"gross_charge":103428.0,"discounted_cash":51714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"LONCASTUXIMAB TESIRINE-LPYL 10 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9359","type":"HCPCS"},{"code":"79952-0110-01","type":"NDC"}],"standard_charges":[{"gross_charge":70260.48,"discounted_cash":35130.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PORFIMER (PHOTOFRIN) SYRINGE","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9600","type":"HCPCS"},{"code":"76128-0155-75","type":"NDC"}],"standard_charges":[{"gross_charge":54704.0,"discounted_cash":27352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"PORFIMER 75 MG IV SOLR","drug_information":{"unit":"1","type":"UN"},"code_information":[{"code":"J9600","type":"HCPCS"},{"code":"76128-0155-75","type":"NDC"}],"standard_charges":[{"gross_charge":54704.0,"discounted_cash":27352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"CARMUSTINE IN POLIFEPROSAN 7.7 MG IMPL WAFR","drug_information":{"unit":"8","type":"UN"},"code_information":[{"code":"J9999","type":"HCPCS"},{"code":"24338-0050-08","type":"NDC"}],"standard_charges":[{"gross_charge":100755.89,"discounted_cash":50377.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"SIPULEUCEL-T-LACTATED RINGERS 50 MILLION CELL/250 ML IV SUSP","drug_information":{"unit":"250","type":"ML"},"code_information":[{"code":"Q2043","type":"HCPCS"},{"code":"30237-8900-06","type":"NDC"}],"standard_charges":[{"gross_charge":191793.55,"discounted_cash":95896.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy"}]},{"description":"Hc Diabetes Training-Individual/30 Mins","code_information":[{"code":"00050108","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Diabetes Training-Group/30 Mins","code_information":[{"code":"00050109","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Diabetes Training-Group Gestnl/30 Min","code_information":[{"code":"00052109","type":"CDM"},{"code":"942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Infusaport Draw","code_information":[{"code":"00520001","type":"CDM"},{"code":"300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Sq/Im Injection","code_information":[{"code":"00520372","type":"CDM"},{"code":"450","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bil Drain/Inj Major Joint/Bursa W/O Us","code_information":[{"code":"00520611","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":846.0,"discounted_cash":423.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Iv Inf Hyd Init 31-60 Mins","code_information":[{"code":"00520760","type":"CDM"},{"code":"260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Hyd Ea Add 31-60 Mns","code_information":[{"code":"00520761","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Ther Init 16-60 Mins","code_information":[{"code":"00520765","type":"CDM"},{"code":"260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Ther Ea Add 31-60 Mn","code_information":[{"code":"00520766","type":"CDM"},{"code":"260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Sequential 16-60 Min","code_information":[{"code":"00520767","type":"CDM"},{"code":"260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Concurrent 16+ Min","code_information":[{"code":"00520768","type":"CDM"},{"code":"260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":116.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Push Ea Add Same Drug","code_information":[{"code":"00520776","type":"CDM"},{"code":"260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Push Initial","code_information":[{"code":"00521784","type":"CDM"},{"code":"260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Push Ea Additional Drug","code_information":[{"code":"00521786","type":"CDM"},{"code":"260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 1 Visit","code_information":[{"code":"00523333","type":"CDM"},{"code":"760","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 2 Visit","code_information":[{"code":"00523334","type":"CDM"},{"code":"760","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 3 Visit","code_information":[{"code":"00523335","type":"CDM"},{"code":"760","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 4 Visit","code_information":[{"code":"00523336","type":"CDM"},{"code":"760","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 5 Visit","code_information":[{"code":"00523337","type":"CDM"},{"code":"760","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Applicaton On-Body Injector","code_information":[{"code":"00526377","type":"CDM"},{"code":"260","type":"RC"},{"code":"96377","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Infus Init 16-60 Min","code_information":[{"code":"00526410","type":"CDM"},{"code":"335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Inf Ea Addl 31-60 Min","code_information":[{"code":"00526412","type":"CDM"},{"code":"335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Infus Seq 16-60 Min","code_information":[{"code":"00526417","type":"CDM"},{"code":"335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Transfusion","code_information":[{"code":"00526435","type":"CDM"},{"code":"391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Therapeutic Phlebotomy","code_information":[{"code":"00529195","type":"CDM"},{"code":"940","type":"RC"},{"code":"99195","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dexa-Bone Mineral Analysis","code_information":[{"code":"00740063","type":"CDM"},{"code":"320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Echo Myocardial Strain Imaging","code_information":[{"code":"00860399","type":"CDM"},{"code":"483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 2D&M-Mode W/Spctrl & Cf Dplr","code_information":[{"code":"00863306","type":"CDM"},{"code":"483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":2450.0,"discounted_cash":1225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Echo - 2-D & M-Mode - Limited","code_information":[{"code":"00863308","type":"CDM"},{"code":"483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1202.0,"discounted_cash":601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Doppler","code_information":[{"code":"00863320","type":"CDM"},{"code":"483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Doppler - Limited","code_information":[{"code":"00863321","type":"CDM"},{"code":"483","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Color Flow Doppler","code_information":[{"code":"00863325","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Color Flow Doppler- Limited","code_information":[{"code":"00864325","type":"CDM"},{"code":"483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":209.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc 2D Tte W Or W/O Fol W/Con Fu","code_information":[{"code":"00868924","type":"CDM"},{"code":"483","type":"RC"},{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"gross_charge":1861.0,"discounted_cash":930.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 2D&M-Mode Wpectrl & Cfdp W/Con","code_information":[{"code":"00868929","type":"CDM"},{"code":"483","type":"RC"},{"code":"C8929","type":"HCPCS"}],"standard_charges":[{"gross_charge":3463.0,"discounted_cash":1731.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stress 2D&M-Mode W/Ekg","code_information":[{"code":"00869351","type":"CDM"},{"code":"483","type":"RC"},{"code":"93351","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.0,"discounted_cash":777.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mpncd Myeloproliferative Neoplasms Core Diagnostic Panel","code_information":[{"code":"00910036","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.0,"discounted_cash":644.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hdq28 Celiac Genetics","code_information":[{"code":"00913008","type":"CDM"},{"code":"310","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Poliovirus Abs","code_information":[{"code":"00913919","type":"CDM"},{"code":"302","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":214.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Jv617- Jak2 V617 F Mutation","code_information":[{"code":"00918200","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":623.0,"discounted_cash":311.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Picc Line Insertion 5 Yr+ W/O Imaging","code_information":[{"code":"00950569","type":"CDM"},{"code":"361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":3504.0,"discounted_cash":1752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Line Insertion 5+ Yr  W/Imaging Guidance","code_information":[{"code":"00950573","type":"CDM"},{"code":"361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":4071.0,"discounted_cash":2035.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Op Cvad Irrigation","code_information":[{"code":"00956523","type":"CDM"},{"code":"260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Declot W/Thrombolytic Agent","code_information":[{"code":"00956550","type":"CDM"},{"code":"361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.0,"discounted_cash":367.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Regional Anesth Initial Hour","code_information":[{"code":"01010003","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":786.0,"discounted_cash":393.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Regional Anesth Ea Add 30 Mns","code_information":[{"code":"01010004","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":267.0,"discounted_cash":133.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laceration Repair(S)","code_information":[{"code":"01011100","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":502.0,"discounted_cash":251.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Newborn Hearing Aep Scr Auditory Potential","code_information":[{"code":"01012650","type":"CDM"},{"code":"471","type":"RC"},{"code":"92650","type":"HCPCS"}],"standard_charges":[{"gross_charge":896.0,"discounted_cash":448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulse Oximetry Nb Screen","code_information":[{"code":"01014760","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Car Seat/Bed Test Init'l 60 Mn","code_information":[{"code":"01014780","type":"CDM"},{"code":"460","type":"RC"},{"code":"94780","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.0,"discounted_cash":224.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Car Seat/Bed Test Ea Ad 30 Mn","code_information":[{"code":"01014781","type":"CDM"},{"code":"460","type":"RC"},{"code":"94781","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Episiotomy","code_information":[{"code":"01019300","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":752.0,"discounted_cash":376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circumcision Routine","code_information":[{"code":"01023230","type":"CDM"},{"code":"361","type":"RC"},{"code":"54160","type":"HCPCS"}],"standard_charges":[{"gross_charge":683.0,"discounted_cash":341.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transcutaneous Bilirubin","code_information":[{"code":"01028400","type":"CDM"},{"code":"301","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.0,"discounted_cash":27.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Minor Proced Level 1 Initial 30 Min","code_information":[{"code":"01201000","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":4105.0,"discounted_cash":2052.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Level 1 Init'l Hour","code_information":[{"code":"01201001","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":8495.0,"discounted_cash":4247.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Lvl 1 Ea Add 30 Min","code_information":[{"code":"01201002","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Level 2 Init'l Hour","code_information":[{"code":"01201003","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":9060.0,"discounted_cash":4530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Lev 2 Ea Add 30 Min","code_information":[{"code":"01201004","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2447.0,"discounted_cash":1223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Level 3 Init'l Hour","code_information":[{"code":"01201005","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":9627.0,"discounted_cash":4813.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Lev 3 Ea Add 30 Min","code_information":[{"code":"01201006","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":1299.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 1 Initial Hour","code_information":[{"code":"01201025","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":8495.0,"discounted_cash":4247.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 1 Ea Add 30 Min","code_information":[{"code":"01201026","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 2 Initial Hour","code_information":[{"code":"01201027","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":9060.0,"discounted_cash":4530.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 2 Ea Add 30 Min","code_information":[{"code":"01201028","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2447.0,"discounted_cash":1223.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 3 Initial Hour","code_information":[{"code":"01201029","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":9627.0,"discounted_cash":4813.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 3 Ea Add 30 Min","code_information":[{"code":"01201030","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2599.0,"discounted_cash":1299.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Minor Proced Level 1 Ea Add 15 Min","code_information":[{"code":"01201039","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2052.0,"discounted_cash":1026.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Level 4 Init'l Hour","code_information":[{"code":"01201040","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":10012.0,"discounted_cash":5006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or General Lvl 4 Ea Add 30 Min","code_information":[{"code":"01201041","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2704.0,"discounted_cash":1352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 4 Initial Hour","code_information":[{"code":"01201046","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":10012.0,"discounted_cash":5006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Or Ortho Level 4 Ea Add 30 Min","code_information":[{"code":"01201047","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2704.0,"discounted_cash":1352.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Esophageal Motility Stdy*","code_information":[{"code":"01207866","type":"CDM"},{"code":"750","type":"RC"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Capsule Endo Tech Comp","code_information":[{"code":"01207870","type":"CDM"},{"code":"750","type":"RC"},{"code":"91110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.0,"discounted_cash":1250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comptr-Asst Muscskel Navigj Ortho Fluor Images","code_information":[{"code":"01209600","type":"CDM"},{"code":"360","type":"RC"},{"code":"0054T","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comptr-Asst Muscskel Navigj Ortho Ct/Mri","code_information":[{"code":"01209601","type":"CDM"},{"code":"360","type":"RC"},{"code":"0055T","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comptr-Asst Surgical Navigation Muscskel Image-Less","code_information":[{"code":"01209602","type":"CDM"},{"code":"360","type":"RC"},{"code":"20985","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Robotic Surgical System","code_information":[{"code":"01209804","type":"CDM"},{"code":"360","type":"RC"},{"code":"S2900","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.01,"discounted_cash":0.005,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recovery Phase 1 Initial Hour","code_information":[{"code":"01216000","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":1754.0,"discounted_cash":877.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recovery Phase 1 Ea Add 30 Min","code_information":[{"code":"01216001","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":349.0,"discounted_cash":174.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recovery Phase 2 Initial Hour","code_information":[{"code":"01216002","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":527.0,"discounted_cash":263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recovery Phase 2 Ea Add 30 Min","code_information":[{"code":"01216003","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":131.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vaginal Delivery-Routine","code_information":[{"code":"01223233","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":4289.0,"discounted_cash":2144.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vaginal Delivery-Complex","code_information":[{"code":"01223234","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":6433.0,"discounted_cash":3216.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fetal Contraction Stress Test","code_information":[{"code":"01229020","type":"CDM"},{"code":"920","type":"RC"},{"code":"59020","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":257.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fetal Non-Stress Test","code_information":[{"code":"01229025","type":"CDM"},{"code":"920","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":488.0,"discounted_cash":244.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc External Version","code_information":[{"code":"01229412","type":"CDM"},{"code":"720","type":"RC"}],"standard_charges":[{"gross_charge":1892.0,"discounted_cash":946.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc General Anesth Initial Hour","code_information":[{"code":"01240001","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":1023.0,"discounted_cash":511.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc General Anesth Ea Add 30 Mns","code_information":[{"code":"01240002","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":131.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Regional Anesth Initial Hour","code_information":[{"code":"01240003","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Regional Anesth Ea Add 30 Mns","code_information":[{"code":"01240004","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":131.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Monitored Anesth Initial Hour","code_information":[{"code":"01240007","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":775.0,"discounted_cash":387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Monitored Anesth Ea Add 30 Mns","code_information":[{"code":"01240008","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":263.0,"discounted_cash":131.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Sedation Initial Hour","code_information":[{"code":"01240009","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":344.0,"discounted_cash":172.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Sedation Ea Add 30 Mins","code_information":[{"code":"01240010","type":"CDM"},{"code":"370","type":"RC"}],"standard_charges":[{"gross_charge":148.0,"discounted_cash":74.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Venipuncture","code_information":[{"code":"01260760","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Capillary Draw","code_information":[{"code":"01260761","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arterial Draw","code_information":[{"code":"01260762","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Infusaport Draw","code_information":[{"code":"01266591","type":"CDM"},{"code":"300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Central/Picc Line Draw","code_information":[{"code":"01266592","type":"CDM"},{"code":"300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peripheral Iv Line Draw","code_information":[{"code":"01268592","type":"CDM"},{"code":"300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheterization For Urine Specimen Collection","code_information":[{"code":"01269612","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Admin Hepatitis B Vaccine","code_information":[{"code":"01290010","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0010","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chem Sq/Im Inj Nonhorm","code_information":[{"code":"01290401","type":"CDM"},{"code":"331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Sq/Im Inj Horm","code_information":[{"code":"01290402","type":"CDM"},{"code":"331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Hyd Init 31-60 Mins","code_information":[{"code":"01290760","type":"CDM"},{"code":"450","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Hyd Ea Add 31-60 Min","code_information":[{"code":"01290761","type":"CDM"},{"code":"450","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Ther Init 16-60 Mins","code_information":[{"code":"01290765","type":"CDM"},{"code":"450","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Ther Ea Add 31-60 Mn","code_information":[{"code":"01290766","type":"CDM"},{"code":"450","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Sequential 16-60 Min","code_information":[{"code":"01290767","type":"CDM"},{"code":"450","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Inf Concurrent 16+ Min","code_information":[{"code":"01290768","type":"CDM"},{"code":"450","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.0,"discounted_cash":116.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Push Ea Add Same Drug","code_information":[{"code":"01290776","type":"CDM"},{"code":"450","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Push Initial","code_information":[{"code":"01290784","type":"CDM"},{"code":"450","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":676.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sq/Im Injection","code_information":[{"code":"01291372","type":"CDM"},{"code":"260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Critical Team Response<30 Min","code_information":[{"code":"01291440","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2894.0,"discounted_cash":1447.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Critical Team Response>30 Min","code_information":[{"code":"01291441","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3522.0,"discounted_cash":1761.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Minor Surg Proc","code_information":[{"code":"01291501","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Interm Surg Proc","code_information":[{"code":"01291502","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":833.0,"discounted_cash":416.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Major Surg Proc","code_information":[{"code":"01291503","type":"CDM"},{"code":"450","type":"RC"}],"standard_charges":[{"gross_charge":1375.0,"discounted_cash":687.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foley Catheter Insertion","code_information":[{"code":"01291702","type":"CDM"},{"code":"450","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Iv Push Ea Additional Drug","code_information":[{"code":"01291784","type":"CDM"},{"code":"450","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Level 1","code_information":[{"code":"01294941","type":"CDM"},{"code":"450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":161.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Level 2","code_information":[{"code":"01294942","type":"CDM"},{"code":"450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Level 3","code_information":[{"code":"01294943","type":"CDM"},{"code":"450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1016.0,"discounted_cash":508.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Level 4","code_information":[{"code":"01294944","type":"CDM"},{"code":"450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.0,"discounted_cash":790.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Iv Push Ea Add Drug","code_information":[{"code":"01296411","type":"CDM"},{"code":"331","type":"RC"},{"code":"96411","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":81.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Prolong 8+ Hrs Infuse W/Pump","code_information":[{"code":"01296416","type":"CDM"},{"code":"335","type":"RC"},{"code":"96416","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.0,"discounted_cash":379.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Irrigation","code_information":[{"code":"01296523","type":"CDM"},{"code":"260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.0,"discounted_cash":113.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Critical Care:Init 30-74 Mn","code_information":[{"code":"01297973","type":"CDM"},{"code":"450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":3194.0,"discounted_cash":1597.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Critical Care:Ea Add 30 Min","code_information":[{"code":"01297974","type":"CDM"},{"code":"450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.0,"discounted_cash":384.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemo Iv Push Initial","code_information":[{"code":"01298953","type":"CDM"},{"code":"331","type":"RC"},{"code":"96409","type":"HCPCS"}],"standard_charges":[{"gross_charge":496.0,"discounted_cash":248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Same Phys/Qhp <5 Yrs Init 15 Min","code_information":[{"code":"01299151","type":"CDM"},{"code":"450","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Same Phys/Qhp 5/>Yrs Init 15 Min","code_information":[{"code":"01299152","type":"CDM"},{"code":"450","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Same Phys/Qhp Ea Add'l 15 Min","code_information":[{"code":"01299153","type":"CDM"},{"code":"450","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Oth Phys/Qhp 5/>Yrs Init 15 Min","code_information":[{"code":"01299156","type":"CDM"},{"code":"450","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Other Phys/Qhp Ea Add'l 15 Min","code_information":[{"code":"01299157","type":"CDM"},{"code":"450","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Level 5","code_information":[{"code":"01299285","type":"CDM"},{"code":"450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2420.0,"discounted_cash":1210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ed Catheterization For Urine Specimen Collection","code_information":[{"code":"01299612","type":"CDM"},{"code":"300","type":"RC"},{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Linear Cutter Tlc50","code_information":[{"code":"01330113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5950.0,"discounted_cash":2975.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Rld. Linear Stapler","code_information":[{"code":"01330321","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2511.26,"discounted_cash":1255.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forcep Bipolar Jewelers","code_information":[{"code":"01330422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1028.75,"discounted_cash":514.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bayonet Forcep","code_information":[{"code":"01330969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":462.98,"discounted_cash":231.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Cannula Ercp1-Hkb","code_information":[{"code":"01330994_107859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Cannula Ercp1-Hkb","code_information":[{"code":"01330994_128982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Cannula Ercp1-Hkb","code_information":[{"code":"01330994_130006","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Cannula Ercp1-Hkb","code_information":[{"code":"01330994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peritoneal Shunt Passer-36Cm","code_information":[{"code":"01331079_129317","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1607.65,"discounted_cash":803.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Peritoneal Shunt Passer-36Cm","code_information":[{"code":"01331079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1607.65,"discounted_cash":803.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Purse String Device","code_information":[{"code":"01331220","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":528.23,"discounted_cash":264.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Turbowhisker  2.0 3407","code_information":[{"code":"01331252_127510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":423.9,"discounted_cash":211.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade Turbowhisker  2.0 3407","code_information":[{"code":"01331252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":423.9,"discounted_cash":211.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scoop Two Cath 11Cm C-11Hf","code_information":[{"code":"01331262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":833.43,"discounted_cash":416.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Femstop","code_information":[{"code":"01331508","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":947.2,"discounted_cash":473.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scissors Endoscopic","code_information":[{"code":"01331509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1328.74,"discounted_cash":664.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ureteral Dilation Set 240-100","code_information":[{"code":"01331510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1066.86,"discounted_cash":533.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gremini Prd Wire Basket 330106","code_information":[{"code":"01331522","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1329.26,"discounted_cash":664.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Combo Cath Wire Guide Cyt","code_information":[{"code":"01331528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":797.87,"discounted_cash":398.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Retriever Suture Concept S","code_information":[{"code":"01331654","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":423.27,"discounted_cash":211.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Riwolith Probe 2.4Fr","code_information":[{"code":"01331662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2747.25,"discounted_cash":1373.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Riwolith Probe 3.3Fr","code_information":[{"code":"01331663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Quick Stick Pressure Monitor","code_information":[{"code":"01331765","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1103.83,"discounted_cash":551.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Clip Applier","code_information":[{"code":"01331789_104131","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1944.98,"discounted_cash":972.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Clip Applier","code_information":[{"code":"01331789","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1944.98,"discounted_cash":972.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Clip Applier Mcl-20","code_information":[{"code":"01331792","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1143.3,"discounted_cash":571.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hickman Broviac 2.7F Ped Cath","code_information":[{"code":"01331800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1328.67,"discounted_cash":664.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"01331808","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1041.62,"discounted_cash":520.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01331841","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":516.22,"discounted_cash":258.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Bilroth Ii Papillotom","code_information":[{"code":"01331884","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1620.6,"discounted_cash":810.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Nasal Bil Drain Enbo-8","code_information":[{"code":"01331894","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1084.25,"discounted_cash":542.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01331973","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.8,"discounted_cash":562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eye Supp. Lachrimal Intubation","code_information":[{"code":"01332073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.3,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Heater Probe 7Fr","code_information":[{"code":"01332088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phycon Univent Tube 6.5Mm","code_information":[{"code":"01332091","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1316.24,"discounted_cash":658.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stone Basket Gu6350","code_information":[{"code":"01332115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Tandem Xl Cannula 3570","code_information":[{"code":"01332144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":530.97,"discounted_cash":265.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pt Care Tongs Nl5010","code_information":[{"code":"01332224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4087.41,"discounted_cash":2043.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Duragaurd 4Cmx4Cm","code_information":[{"code":"01332230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.52,"discounted_cash":1347.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Duragaurd 8Cmx14Cm","code_information":[{"code":"01332231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5269.32,"discounted_cash":2634.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Linear Cutter Reload","code_information":[{"code":"01332320_111375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Linear Cutter Reload","code_information":[{"code":"01332320_129315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Linear Cutter Reload","code_information":[{"code":"01332320_3619825","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Linear Cutter Reload","code_information":[{"code":"01332320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"01332625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5113.6,"discounted_cash":2556.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Occlusion","code_information":[{"code":"01333034","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.15,"discounted_cash":1238.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Autosuture Roticulator Cart.","code_information":[{"code":"01333053_102781","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1484.74,"discounted_cash":742.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Autosuture Roticulator Cart.","code_information":[{"code":"01333053","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1484.74,"discounted_cash":742.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Round Fluted #5130-10-30","code_information":[{"code":"01333063","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":716.16,"discounted_cash":358.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Goretex Cardiovascular Patch","code_information":[{"code":"01333068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1820.4,"discounted_cash":910.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spetzler Reservoir","code_information":[{"code":"01333082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3616.78,"discounted_cash":1808.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01333084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1391.72,"discounted_cash":695.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Round Diamond #5130-12-40","code_information":[{"code":"01333087_127282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.8,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Burr Round Diamond #5130-12-40","code_information":[{"code":"01333087_17589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.8,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Burr Round Diamond #5130-12-40","code_information":[{"code":"01333087","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.8,"discounted_cash":396.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor Stays (Order 10Pk)","code_information":[{"code":"01333390_18438","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":563.35,"discounted_cash":281.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Retractor Stays (Order 10Pk)","code_information":[{"code":"01333390","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.95,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valvulotome Lemaitre Exand.","code_information":[{"code":"01333435","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17694.1,"discounted_cash":8847.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"01333677","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1831.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Incisor","code_information":[{"code":"01333687","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":509.39,"discounted_cash":254.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Seprafilm 430102","code_information":[{"code":"01333773_20555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4085.4,"discounted_cash":2042.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Seprafilm 430102","code_information":[{"code":"01333773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4149.4,"discounted_cash":2074.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Phycon Univent 8.0","code_information":[{"code":"01333877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Incisor 4.5 Crud","code_information":[{"code":"01334008","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":632.08,"discounted_cash":316.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Short 4.0Mm Stryker","code_information":[{"code":"01334021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.2,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flow Suction Irrigator Pump","code_information":[{"code":"01334160_23229","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":423.84,"discounted_cash":211.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Flow Suction Irrigator Pump","code_information":[{"code":"01334160_3580908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":430.44,"discounted_cash":215.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flow Suction Irrigator Pump","code_information":[{"code":"01334160","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":430.44,"discounted_cash":215.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eye Lacrimal Intub W/Suture","code_information":[{"code":"01334173_23314","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Eye Lacrimal Intub W/Suture","code_information":[{"code":"01334173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Interceed Absorb Adhes Barrier","code_information":[{"code":"01334176","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2928.51,"discounted_cash":1464.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_114082","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128005","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128006","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128007","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128008","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128009","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128010","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128011","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128014","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128015","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128017","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128018","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128019","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128020","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128021","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128022","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128023","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128024","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128025","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128026","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128027","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128028","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128029","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128030","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128031","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128033","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_128034","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3585792","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3585929","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3585931","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3585945","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3585948","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3586097","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"01334290_3586342","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Guide Gfs-10A","code_information":[{"code":"01334291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":624.08,"discounted_cash":312.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basket Disp Lithocrush","code_information":[{"code":"01334327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2812.22,"discounted_cash":1406.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent W Delivery System","code_information":[{"code":"01334596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.8,"discounted_cash":562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Double Lumen Arrowgard","code_information":[{"code":"01334612","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Rb-24Fr Bent Rolle","code_information":[{"code":"01334621","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.65,"discounted_cash":410.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneler Sheath & Bullet Tap","code_information":[{"code":"01334636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":524.38,"discounted_cash":262.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lap/Chol Karlan Introducer","code_information":[{"code":"01334757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1019.72,"discounted_cash":509.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cup Biopsy Forcep 3Fr","code_information":[{"code":"01334759","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2566.91,"discounted_cash":1283.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nephrostomy Kit Nephromax","code_information":[{"code":"01334893","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1891.59,"discounted_cash":945.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Perf Retrograde","code_information":[{"code":"01334895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":668.58,"discounted_cash":334.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01334910_22667","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01334910","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Dual Lumen Stone 405-100","code_information":[{"code":"01334912","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1758","type":"HCPCS"}],"standard_charges":[{"gross_charge":519.98,"discounted_cash":259.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Hickman Perc Kit 7Fr","code_information":[{"code":"01334926","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgicel Fibrillar 2X4","code_information":[{"code":"01334960_24981","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1449.44,"discounted_cash":724.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Surgicel Fibrillar 2X4","code_information":[{"code":"01334960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1440.08,"discounted_cash":720.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Loop 24Fr","code_information":[{"code":"01334974_127314","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":973.94,"discounted_cash":486.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrode Loop 24Fr","code_information":[{"code":"01334974","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":939.02,"discounted_cash":469.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Cre","code_information":[{"code":"01334979","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1271.22,"discounted_cash":635.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"01335349","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.78,"discounted_cash":243.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgicel 2 X 14 In","code_information":[{"code":"01335553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.65,"discounted_cash":477.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgicel 2 X 3 In.","code_information":[{"code":"01335554_5058","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":597.04,"discounted_cash":298.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Surgicel 2 X 3 In.","code_information":[{"code":"01335554","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":594.45,"discounted_cash":297.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgicel 4 X 8 In","code_information":[{"code":"01335555_5060","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1014.16,"discounted_cash":507.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Surgicel 4 X 8 In","code_information":[{"code":"01335555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1008.8,"discounted_cash":504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"01335775","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.15,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Curled Hemodialysis","code_information":[{"code":"01336103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.94,"discounted_cash":644.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vari Stim Iii Nerve Stimulato","code_information":[{"code":"01336211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.65,"discounted_cash":207.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thermodilution Catheter  7 Fr.","code_information":[{"code":"01336322_3580613","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":455.3,"discounted_cash":227.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Thermodilution Catheter  7 Fr.","code_information":[{"code":"01336322","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.02,"discounted_cash":324.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thermodilution Catheter  7 Fr.","code_information":[{"code":"01336322_6881","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":648.02,"discounted_cash":324.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ureteral Stent  Double 20-28Cm","code_information":[{"code":"01336418","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.6,"discounted_cash":736.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Raimondi Peritoneal Catheter","code_information":[{"code":"01336420","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1434.12,"discounted_cash":717.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ommaya Csf Reservoir","code_information":[{"code":"01336426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3166.98,"discounted_cash":1583.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Parsonnet Dilator Probe","code_information":[{"code":"01336576","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thermodilution Catheter  7.5Fr","code_information":[{"code":"01336706","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":836.2,"discounted_cash":418.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"01336895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3563.2,"discounted_cash":1781.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Connector Str.#82-1501","code_information":[{"code":"01337433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1120.06,"discounted_cash":560.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"\"Hc 12\"\" Pruitt-Inahara T-Shunt\"","code_information":[{"code":"01338064","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7353.6,"discounted_cash":3676.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Connector Three-Way","code_information":[{"code":"01338523","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":893.4,"discounted_cash":446.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle  Lung Biopsy 1120","code_information":[{"code":"01338644_124751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle  Lung Biopsy 1120","code_information":[{"code":"01338644_124770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle  Lung Biopsy 1120","code_information":[{"code":"01338644","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ureteral Stent","code_information":[{"code":"01338791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.2,"discounted_cash":381.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aneurysm Clip Yasargil","code_information":[{"code":"01338926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3209.31,"discounted_cash":1604.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Connect/Str/Plas 82-1504","code_information":[{"code":"01338938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":918.19,"discounted_cash":459.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pediatric Pack Rci","code_information":[{"code":"01339173","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":544.08,"discounted_cash":272.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01339208","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.32,"discounted_cash":216.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Intracran. Pres. Mon.Kit","code_information":[{"code":"01339297","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5430.89,"discounted_cash":2715.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Tray Dbl Lumen 5Cm 4Fr","code_information":[{"code":"01339718","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.96,"discounted_cash":537.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 1 Fluid Warmer D-300","code_information":[{"code":"01339754","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":721.7,"discounted_cash":360.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level 1 Fluid Warmer D-300","code_information":[{"code":"01339754_4499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":721.7,"discounted_cash":360.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cath Arrow Kit Ak-24703","code_information":[{"code":"01339945","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.55,"discounted_cash":247.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Art/Embol 2Fr/60Cm Cv1035","code_information":[{"code":"01339967_107192","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.3,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cath Art/Embol 2Fr/60Cm Cv1035","code_information":[{"code":"01339967","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.3,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Home Sleep Test/Type 3 Porta","code_information":[{"code":"01360399","type":"CDM"},{"code":"740","type":"RC"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.0,"discounted_cash":685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Home Slp Stdy Unattended Watchpat <6 Hrs Rec","code_information":[{"code":"01365800","type":"CDM"},{"code":"740","type":"RC"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.0,"discounted_cash":1029.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc Home Slp Stdy Unattended Watchpat 6+Hrs Rec","code_information":[{"code":"01365801","type":"CDM"},{"code":"740","type":"RC"},{"code":"95800","type":"HCPCS"}],"standard_charges":[{"gross_charge":2059.0,"discounted_cash":1029.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Slp Study 6/>Yrs Cpap 4/> Parm <6 Hrs Recording","code_information":[{"code":"01365811","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":6825.0,"discounted_cash":3412.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc Elec Alys Implt Smpl (3 Or Less) Cn Npgt Prgrmg","code_information":[{"code":"01365976","type":"CDM"},{"code":"920","type":"RC"},{"code":"95976","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elec Alys Implt Cplx (4 Or Greater) Cn Npgt Prgrmg","code_information":[{"code":"01365977","type":"CDM"},{"code":"920","type":"RC"},{"code":"95977","type":"HCPCS"}],"standard_charges":[{"gross_charge":809.0,"discounted_cash":404.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sleep Study 6/> Yrs 4/> Param <6 Hrs Recording","code_information":[{"code":"01369810","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":6825.0,"discounted_cash":3412.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc Culture  Misc.","code_information":[{"code":"01412726","type":"CDM"},{"code":"306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.0,"discounted_cash":115.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Specimen Handling","code_information":[{"code":"01418039","type":"CDM"},{"code":"300","type":"RC"},{"code":"DAKIT","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Potassium I-Stat","code_information":[{"code":"01424132","type":"CDM"},{"code":"301","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sodium I-Stat","code_information":[{"code":"01424295","type":"CDM"},{"code":"301","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":72.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hematocrit I-Stat","code_information":[{"code":"01425014","type":"CDM"},{"code":"305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.0,"discounted_cash":55.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Gas Profile - I-Stat","code_information":[{"code":"01426664","type":"CDM"},{"code":"301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lactic Acid I-Stat","code_information":[{"code":"01426705","type":"CDM"},{"code":"301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basic Metabolic Ionized Ca I-Stat","code_information":[{"code":"01428200","type":"CDM"},{"code":"301","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anatomical Pathology","code_information":[{"code":"01440232","type":"CDM"},{"code":"310","type":"RC"}],"standard_charges":[{"gross_charge":261.4,"discounted_cash":130.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc G&M Surg Path-Level Iv","code_information":[{"code":"01441058","type":"CDM"},{"code":"312","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":301.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Immunoperoxidase","code_information":[{"code":"01449552","type":"CDM"},{"code":"312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.0,"discounted_cash":298.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrocardiogram","code_information":[{"code":"01503215","type":"CDM"},{"code":"730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":120.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ecg Up To 48 Hrs Scan Analys Rprt Holter","code_information":[{"code":"01503226","type":"CDM"},{"code":"731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":354.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Zio Xt 3-7 Days","code_information":[{"code":"01503242","type":"CDM"},{"code":"730","type":"RC"},{"code":"93242","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Zio Xt 7-15 Days","code_information":[{"code":"01503246","type":"CDM"},{"code":"730","type":"RC"},{"code":"93246","type":"HCPCS"}],"standard_charges":[{"gross_charge":241.0,"discounted_cash":120.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Event Recording","code_information":[{"code":"01503270","type":"CDM"},{"code":"731","type":"RC"},{"code":"93270","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Event Transmission & Analysis","code_information":[{"code":"01503271","type":"CDM"},{"code":"731","type":"RC"},{"code":"93271","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ekg Stress Test","code_information":[{"code":"01503935","type":"CDM"},{"code":"482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ext Ecg Monit/Reprt 12-48 Hrs","code_information":[{"code":"01505069","type":"CDM"},{"code":"731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sleep Study 6/> Yrs 4/> Param 6+ Hrs Recording","code_information":[{"code":"01520010","type":"CDM"},{"code":"740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":6825.0,"discounted_cash":3412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Slp Study 6/>Yrs Cpap 4/> Parm 6+ Hrs Recording","code_information":[{"code":"01520011","type":"CDM"},{"code":"740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":6825.0,"discounted_cash":3412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mslt 4+ Nap Recordings","code_information":[{"code":"01520012","type":"CDM"},{"code":"740","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":3619.0,"discounted_cash":1809.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eeg  Awake & Drowsy","code_information":[{"code":"01523383","type":"CDM"},{"code":"740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eeg Over 1 Hour","code_information":[{"code":"01525813","type":"CDM"},{"code":"740","type":"RC"},{"code":"95813","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eeg Awaking/Asleep","code_information":[{"code":"01525819","type":"CDM"},{"code":"740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1162.0,"discounted_cash":581.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Robotic Srs Initial Fraction","code_information":[{"code":"01540339","type":"CDM"},{"code":"333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":8205.0,"discounted_cash":4102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Robotic Srs Subsequent Fract","code_information":[{"code":"01540340","type":"CDM"},{"code":"333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":8205.0,"discounted_cash":4102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stereoscopic X-Ray Guidance","code_information":[{"code":"01540421","type":"CDM"},{"code":"333","type":"RC"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Guidance-Radiation Therapy","code_information":[{"code":"01546370","type":"CDM"},{"code":"333","type":"RC"},{"code":"77014","type":"HCPCS"}],"standard_charges":[{"gross_charge":615.0,"discounted_cash":307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri/Ct/Pet Fusion","code_information":[{"code":"01546499","type":"CDM"},{"code":"333","type":"RC"},{"code":"77299","type":"HCPCS"}],"standard_charges":[{"gross_charge":1833.0,"discounted_cash":916.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Simulation-Simple","code_information":[{"code":"01547280","type":"CDM"},{"code":"333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Simulation-Complex","code_information":[{"code":"01547290","type":"CDM"},{"code":"333","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Respirator Motion Mgmt Simul","code_information":[{"code":"01547294","type":"CDM"},{"code":"333","type":"RC"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":1312.0,"discounted_cash":656.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Radiation Therapy Field 3D","code_information":[{"code":"01547295","type":"CDM"},{"code":"333","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5845.0,"discounted_cash":2922.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dosimetry-Basic","code_information":[{"code":"01547300","type":"CDM"},{"code":"333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Imrt Planning","code_information":[{"code":"01547301","type":"CDM"},{"code":"333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":5845.0,"discounted_cash":2922.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isodose Plan-Complex","code_information":[{"code":"01547315","type":"CDM"},{"code":"333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Special Port Plan","code_information":[{"code":"01547321","type":"CDM"},{"code":"333","type":"RC"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dosimetry-Special","code_information":[{"code":"01547331","type":"CDM"},{"code":"333","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Design Molds/Mask - Simple","code_information":[{"code":"01547332","type":"CDM"},{"code":"333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Design Molds/Mask - Complex","code_information":[{"code":"01547334","type":"CDM"},{"code":"333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Continued Radiation Physics","code_information":[{"code":"01547336","type":"CDM"},{"code":"333","type":"RC"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mlc Device For Imrt","code_information":[{"code":"01547338","type":"CDM"},{"code":"333","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Special Physics Consult","code_information":[{"code":"01547370","type":"CDM"},{"code":"333","type":"RC"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.0,"discounted_cash":303.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Imrt Ntsty Modul Rad Tx Dlvr Simple","code_information":[{"code":"01547385","type":"CDM"},{"code":"333","type":"RC"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Imrt Ntsty Modul Rad Tx Dlvr Compelx","code_information":[{"code":"01547386","type":"CDM"},{"code":"333","type":"RC"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Radiation Treatment Delivery, >1Mev; Simple","code_information":[{"code":"01547402","type":"CDM"},{"code":"333","type":"RC"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Radiation Treatment Delivery, >1Mev; Complex","code_information":[{"code":"01547412","type":"CDM"},{"code":"333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.0,"discounted_cash":562.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Film - One","code_information":[{"code":"01547417","type":"CDM"},{"code":"333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":36.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Films - Two","code_information":[{"code":"01547418","type":"CDM"},{"code":"333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":47.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Special Treatment Proc","code_information":[{"code":"01547470","type":"CDM"},{"code":"333","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2520.0,"discounted_cash":1260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Complex Immobilization Device","code_information":[{"code":"01548334","type":"CDM"},{"code":"333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1581.0,"discounted_cash":790.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Abdomen-Mrcp W/O Contrast","code_information":[{"code":"01570181","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Abdomen-Mrcp W/Contrast","code_information":[{"code":"01570182","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5277.0,"discounted_cash":2638.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Abdomen-Mrcp W/Wo Contrast","code_information":[{"code":"01570183","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":2458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Orbit Face & Neck W/Wo Con","code_information":[{"code":"01570543","type":"CDM"},{"code":"610","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":4711.0,"discounted_cash":2355.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Head W/O Contrast","code_information":[{"code":"01570544","type":"CDM"},{"code":"615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":2865.0,"discounted_cash":1432.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Head W/Contrast","code_information":[{"code":"01570545","type":"CDM"},{"code":"615","type":"RC"},{"code":"70545","type":"HCPCS"}],"standard_charges":[{"gross_charge":4417.0,"discounted_cash":2208.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Head W/Wo Contrast","code_information":[{"code":"01570546","type":"CDM"},{"code":"615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":4139.0,"discounted_cash":2069.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Neck W/O Contrast","code_information":[{"code":"01570547","type":"CDM"},{"code":"615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":2865.0,"discounted_cash":1432.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Neck W/Wo Contrast","code_information":[{"code":"01570549","type":"CDM"},{"code":"615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5728.0,"discounted_cash":2864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain W/O Contrast","code_information":[{"code":"01570551","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1419.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain W/Contrast","code_information":[{"code":"01570552","type":"CDM"},{"code":"611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":4490.0,"discounted_cash":2245.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain W/Wo Contrast","code_information":[{"code":"01570553","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Chest W/Wo Contrast","code_information":[{"code":"01571552","type":"CDM"},{"code":"610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":4413.0,"discounted_cash":2206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Cervical Spine W/O Con","code_information":[{"code":"01572141","type":"CDM"},{"code":"612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1419.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Cervical Spine W/Con","code_information":[{"code":"01572142","type":"CDM"},{"code":"612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":4515.0,"discounted_cash":2257.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Thoracic Spine W/O Con","code_information":[{"code":"01572146","type":"CDM"},{"code":"612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Thoracic Spine W/Con","code_information":[{"code":"01572147","type":"CDM"},{"code":"612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.0,"discounted_cash":2369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Lumbar Spine W/O Contrast","code_information":[{"code":"01572148","type":"CDM"},{"code":"612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Lumbar Spine W/Contrast","code_information":[{"code":"01572149","type":"CDM"},{"code":"612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":4738.0,"discounted_cash":2369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Cervical Spine W/Wo Con","code_information":[{"code":"01572156","type":"CDM"},{"code":"612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Thoracic Spine W/Wo Con","code_information":[{"code":"01572157","type":"CDM"},{"code":"612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":4891.0,"discounted_cash":2445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Lumbar Spine W/Wo Contrast","code_information":[{"code":"01572158","type":"CDM"},{"code":"612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":4891.0,"discounted_cash":2445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Pelvis W/O Contrast","code_information":[{"code":"01572196","type":"CDM"},{"code":"610","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":1524.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Pelvis W/Wo Contrast","code_information":[{"code":"01572197","type":"CDM"},{"code":"610","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":2458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Upper Extremity W/O Con Lt","code_information":[{"code":"01573220","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3098.0,"discounted_cash":1549.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/O Con Lt","code_information":[{"code":"01573221","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Shoulder W/O Contrast Lt","code_information":[{"code":"01573222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/Wo Con L","code_information":[{"code":"01573223","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Lower Extremity W/Wo Con L","code_information":[{"code":"01573718","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.0,"discounted_cash":2420.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Lower Extremity W/O Con Lt","code_information":[{"code":"01573720","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":1524.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/O Con Lt","code_information":[{"code":"01573721","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Knee W/O Contrast Lt","code_information":[{"code":"01573722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri Hip W/O Contrast","code_information":[{"code":"01573723","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Mrcp","code_information":[{"code":"01574180","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Abdomen W/O Contrast","code_information":[{"code":"01574181","type":"CDM"},{"code":"610","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.0,"discounted_cash":1497.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Abdomen W/Wo Contrast","code_information":[{"code":"01574183","type":"CDM"},{"code":"610","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":4917.0,"discounted_cash":2458.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Upper Extremity W/Wo Con L","code_information":[{"code":"01574220","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.0,"discounted_cash":2472.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/Con Lt","code_information":[{"code":"01574222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Shoulder W/Wo Contrast Lt","code_information":[{"code":"01574223","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/Con Lt","code_information":[{"code":"01574722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/Wo Con L","code_information":[{"code":"01574723","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Abdomen W/Contrast","code_information":[{"code":"01575182","type":"CDM"},{"code":"610","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":5277.0,"discounted_cash":2638.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Shoulder W/Contrast Lt","code_information":[{"code":"01575222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Iac W/O Con","code_information":[{"code":"01577540","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1419.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri- Iac W/Wo Con","code_information":[{"code":"01577543","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain Atn Pitutry W/Wo Con","code_information":[{"code":"01577553","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain Attn Orbits W/Wo Con","code_information":[{"code":"01578553","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mra-Abdomen W/Wo Contrast","code_information":[{"code":"01578902","type":"CDM"},{"code":"618","type":"RC"},{"code":"74185","type":"HCPCS"}],"standard_charges":[{"gross_charge":5328.0,"discounted_cash":2664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri Breast Bilateral Wo Con","code_information":[{"code":"01578907","type":"CDM"},{"code":"610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2905.0,"discounted_cash":1452.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri Breast Bilateral W/Wo Con","code_information":[{"code":"01578908","type":"CDM"},{"code":"610","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":5764.0,"discounted_cash":2882.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brachial Plexus Upper Extremity W/O Con Bi","code_information":[{"code":"01579218","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3875.0,"discounted_cash":1937.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Brachial Plexus Upper Extremity W/Wo Con B","code_information":[{"code":"01579220","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.0,"discounted_cash":2472.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Brain Attn Iac Wo Con","code_information":[{"code":"01579551","type":"CDM"},{"code":"611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2838.0,"discounted_cash":1419.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Brain Attn Iac W/Wo Con","code_information":[{"code":"01579553","type":"CDM"},{"code":"611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":4635.0,"discounted_cash":2317.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accustick Intro Set","code_information":[{"code":"01590023","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":558.92,"discounted_cash":279.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vena Cava Filter","code_information":[{"code":"01590025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":7545.6,"discounted_cash":3772.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gooseneck Snare","code_information":[{"code":"01590039","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Infusion Cragg-Mcnamara Valved","code_information":[{"code":"01590046","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"01590052","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.46,"discounted_cash":208.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"01590053","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4406.4,"discounted_cash":2203.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Infusion Cragg-Mcnamara Valved","code_information":[{"code":"01590058","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Px Nfrosgrm &/Urtrgrm Exist Access","code_information":[{"code":"01590431","type":"CDM"},{"code":"361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":2615.0,"discounted_cash":1307.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plmt Nephrostomy Catheter","code_information":[{"code":"01590432","type":"CDM"},{"code":"361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":7866.0,"discounted_cash":3933.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Exchange Nephrostomy Cath","code_information":[{"code":"01590435","type":"CDM"},{"code":"361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":7138.0,"discounted_cash":3569.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthrocentesis Aspir&/Inj Small Jt/Bursa W/O Us","code_information":[{"code":"01590600","type":"CDM"},{"code":"360","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ins Suprapubic Cath For Asp","code_information":[{"code":"01591010","type":"CDM"},{"code":"361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":7045.0,"discounted_cash":3522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Change Of Cyst Tube  Simple","code_information":[{"code":"01591705","type":"CDM"},{"code":"361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.0,"discounted_cash":451.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perq Vertebroplasty Ls/Ct Ea Add Vert Body Im Guidance","code_information":[{"code":"01592512","type":"CDM"},{"code":"361","type":"RC"},{"code":"22512","type":"HCPCS"}],"standard_charges":[{"gross_charge":6158.0,"discounted_cash":3079.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perq Vertebral Augmentation Kyphoplasty Thoracic","code_information":[{"code":"01592513","type":"CDM"},{"code":"361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":19697.0,"discounted_cash":9848.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perq Vertebral Augmentation Kyphoplasty Lumbar","code_information":[{"code":"01592514","type":"CDM"},{"code":"361","type":"RC"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":19697.0,"discounted_cash":9848.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perq Vertebral Augmentation Kyphoplasty Ea Add'l","code_information":[{"code":"01592515","type":"CDM"},{"code":"361","type":"RC"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":19697.0,"discounted_cash":9848.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"01593231","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Transjugular Set","code_information":[{"code":"01593265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Ash Dialysis","code_information":[{"code":"01593277","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01593281","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1089.35,"discounted_cash":544.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tilt Table Study","code_information":[{"code":"01593660","type":"CDM"},{"code":"480","type":"RC"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":2080.0,"discounted_cash":1040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aortagram W/Runoff","code_information":[{"code":"01595630","type":"CDM"},{"code":"320","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":4929.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluoro Venous Cath Placement","code_information":[{"code":"01595998","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":214.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthrocentesis/Asp/Inj Maj Jnt","code_information":[{"code":"01596003","type":"CDM"},{"code":"361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":1088.0,"discounted_cash":544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Fluoro Assist Up To 1 Hr","code_information":[{"code":"01596307","type":"CDM"},{"code":"320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.0,"discounted_cash":536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Non-Tun Cath/Central Line 5+","code_information":[{"code":"01596556","type":"CDM"},{"code":"361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":2967.0,"discounted_cash":1483.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Insert  Chest 5+","code_information":[{"code":"01596561","type":"CDM"},{"code":"361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":11394.0,"discounted_cash":5697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Removal","code_information":[{"code":"01596590","type":"CDM"},{"code":"361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":5595.0,"discounted_cash":2797.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ins Endovas Vena Cava Filtr","code_information":[{"code":"01597191","type":"CDM"},{"code":"361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":9607.0,"discounted_cash":4803.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iliac Revasc Initial","code_information":[{"code":"01597220","type":"CDM"},{"code":"361","type":"RC"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":25045.0,"discounted_cash":12522.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iliac Revasc W/Stent Initl","code_information":[{"code":"01597221","type":"CDM"},{"code":"361","type":"RC"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":32540.0,"discounted_cash":16270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fem/Popl Revas W/Tla","code_information":[{"code":"01597224","type":"CDM"},{"code":"361","type":"RC"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":16278.0,"discounted_cash":8139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tib/Per Revasc W/Tla Init Ves","code_information":[{"code":"01597228","type":"CDM"},{"code":"361","type":"RC"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":34252.0,"discounted_cash":17126.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Injection For Cholangiogram Exist Access","code_information":[{"code":"01597531","type":"CDM"},{"code":"361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":12361.0,"discounted_cash":6180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fluoro Guidance For Ndl Place","code_information":[{"code":"01597600","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.0,"discounted_cash":257.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dx Bone Marrow Bx & Aspir Ir","code_information":[{"code":"01598222","type":"CDM"},{"code":"361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":9247.0,"discounted_cash":4623.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluoro Guidance For Ndl Place Bilateral","code_information":[{"code":"01598802","type":"CDM"},{"code":"320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.0,"discounted_cash":316.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abd Paracentesis W/Imaging","code_information":[{"code":"01599083","type":"CDM"},{"code":"361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insert Tun Ip Cath Perc","code_information":[{"code":"01599418","type":"CDM"},{"code":"361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":12093.0,"discounted_cash":6046.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ther Proc-Strngth/Endur/15 Min","code_information":[{"code":"01600237","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0237","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ther Proc-Resp Function/15 Min","code_information":[{"code":"01600238","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ther Proc Group-Resp Function","code_information":[{"code":"01600239","type":"CDM"},{"code":"410","type":"RC"},{"code":"G0239","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pad Rehab Per Session; 1-36","code_information":[{"code":"01603668","type":"CDM"},{"code":"480","type":"RC"},{"code":"93668","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":65.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Rehab Ii; 37+","code_information":[{"code":"01603798","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":175.0,"setting":"both","modifiers":"KX","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier KX: Requirements specified in the medical policy have been met"}]},{"description":"Hc Pulmonary Stress Test/Simple","code_information":[{"code":"01604620","type":"CDM"},{"code":"460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":161.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aerosol/Mdi Instruction","code_information":[{"code":"01604664","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Rehab Ii; 1-36","code_information":[{"code":"01609063","type":"CDM"},{"code":"943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraop-Fluoro <1 Hr W/O Image","code_information":[{"code":"01610005","type":"CDM"},{"code":"360","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.0,"discounted_cash":536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraop-Fluoro < 1 Hr W/Image","code_information":[{"code":"01610006","type":"CDM"},{"code":"360","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.0,"discounted_cash":536.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraop-Fluoro >1 Hr W/O Image","code_information":[{"code":"01610007","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraop-Fluoro  > 1 Hr W/Image","code_information":[{"code":"01610008","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1464.0,"discounted_cash":732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Mandible Min 4 Views","code_information":[{"code":"01610110","type":"CDM"},{"code":"320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Facial Bones < 3 Views","code_information":[{"code":"01610140","type":"CDM"},{"code":"320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.0,"discounted_cash":155.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Facial Bones 3+ Views","code_information":[{"code":"01610150","type":"CDM"},{"code":"320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Nasal Bones 3+ Views","code_information":[{"code":"01610160","type":"CDM"},{"code":"320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Orbits 2 View Pre-Mri Fb","code_information":[{"code":"01610190","type":"CDM"},{"code":"320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":180.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Orbits For Trauma","code_information":[{"code":"01610200","type":"CDM"},{"code":"320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Paranasal Sinuses Min 3 Views","code_information":[{"code":"01610220","type":"CDM"},{"code":"320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Skull 4 Or More Views","code_information":[{"code":"01610260","type":"CDM"},{"code":"320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Skull 3 Or Less Views","code_information":[{"code":"01610261","type":"CDM"},{"code":"320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Neck (Soft Tissue)","code_information":[{"code":"01610360","type":"CDM"},{"code":"320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/O Us","code_information":[{"code":"01610605","type":"CDM"},{"code":"360","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":687.0,"discounted_cash":343.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cv Cath Injection W/Fluor","code_information":[{"code":"01610784","type":"CDM"},{"code":"361","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":911.0,"discounted_cash":455.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Chest 1 View","code_information":[{"code":"01611010","type":"CDM"},{"code":"324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Chest 4+ Views","code_information":[{"code":"01611039","type":"CDM"},{"code":"324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.0,"discounted_cash":247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Chest 2 Views","code_information":[{"code":"01611046","type":"CDM"},{"code":"324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Chest 3 Views","code_information":[{"code":"01611047","type":"CDM"},{"code":"324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01611080_24666","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01611080_99272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"01611080","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ribs 2 Views Unilateral Lt","code_information":[{"code":"01611100","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Ribs Unilat W/Pa Chest L 3+ Views","code_information":[{"code":"01611101","type":"CDM"},{"code":"324","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Ribs 3 Views Bilateral","code_information":[{"code":"01611110","type":"CDM"},{"code":"320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ribs Bilaterl W/Pa Chest 4+ Views","code_information":[{"code":"01611111","type":"CDM"},{"code":"320","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Sternum 2+ Views","code_information":[{"code":"01611120","type":"CDM"},{"code":"320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Cystography/Void Urethcyst","code_information":[{"code":"01611600","type":"CDM"},{"code":"361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.0,"discounted_cash":461.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Spine Entire 2-3 Views","code_information":[{"code":"01612010","type":"CDM"},{"code":"320","type":"RC"},{"code":"72082","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Spine Entire 1 View","code_information":[{"code":"01612015","type":"CDM"},{"code":"320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Cerv Spine 2 Or 3 Views","code_information":[{"code":"01612040","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Cervical Spine Min 4-5 Views","code_information":[{"code":"01612050","type":"CDM"},{"code":"320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Cerv Sp Comp W Flex/Ext 6+ Views","code_information":[{"code":"01612052","type":"CDM"},{"code":"320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Cerv Spine-Flex & Ext 2-3 Views","code_information":[{"code":"01612055","type":"CDM"},{"code":"320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Thoracic Spine 3 Views","code_information":[{"code":"01612070","type":"CDM"},{"code":"320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Of Thoracic Spine 4+ Views","code_information":[{"code":"01612074","type":"CDM"},{"code":"320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ls Spine 2 Or 3 Views","code_information":[{"code":"01612100","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ls Spine W/Flex & Ext 6+ Views","code_information":[{"code":"01612105","type":"CDM"},{"code":"320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ls Spine Min 4 Views","code_information":[{"code":"01612110","type":"CDM"},{"code":"320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ls Spine Bending 2-3 Views","code_information":[{"code":"01612120","type":"CDM"},{"code":"320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Pelvis 1 Or 2 Views","code_information":[{"code":"01612170","type":"CDM"},{"code":"320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Pelvis Min 3 Views","code_information":[{"code":"01612190","type":"CDM"},{"code":"320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Sacroiliac Joints 3+ Views","code_information":[{"code":"01612202","type":"CDM"},{"code":"320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Sacrum / Coccyx 2+ Views","code_information":[{"code":"01612221","type":"CDM"},{"code":"320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myelography Via Lumbar Inj; Cervical","code_information":[{"code":"01612302","type":"CDM"},{"code":"361","type":"RC"},{"code":"62302","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myelography Via Lumbar Inj; Thoracic","code_information":[{"code":"01612303","type":"CDM"},{"code":"361","type":"RC"},{"code":"62303","type":"HCPCS"}],"standard_charges":[{"gross_charge":2574.0,"discounted_cash":1287.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Myelography Via Lumbar Inj; Lumbosacral","code_information":[{"code":"01612304","type":"CDM"},{"code":"361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dx Lmbr Spi Pnxr W/Fluor","code_information":[{"code":"01612328","type":"CDM"},{"code":"361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.0,"discounted_cash":1394.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Clavicle Lt","code_information":[{"code":"01613000","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Scapula Lt","code_information":[{"code":"01613010","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":349.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Shoulder Single View Lt","code_information":[{"code":"01613020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Shoulder Min 2 Views Lt","code_information":[{"code":"01613031","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Humerus Min 2 Views Lt","code_information":[{"code":"01613060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Elbow Min 3 Views Lt","code_information":[{"code":"01613070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Forearm 2 Views Lt","code_information":[{"code":"01613090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Wrist 2 Views Lt","code_information":[{"code":"01613100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Wrist 3 Views Lt","code_information":[{"code":"01613110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Hand 2 Views Lt","code_information":[{"code":"01613120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":283.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Hand Min 3 Views Lt","code_information":[{"code":"01613130","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Finger 2+ Views Lt","code_information":[{"code":"01613140","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Inj Shoulder Arthrogram Lt","code_information":[{"code":"01613350","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Hip Ap Only Lt","code_information":[{"code":"01613500","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray Exam Hip Uni 2-3 Views Lt","code_information":[{"code":"01613510","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray Exam Hips Bi 2 Views","code_information":[{"code":"01613521","type":"CDM"},{"code":"320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Hips Bi 3-4 Views","code_information":[{"code":"01613522","type":"CDM"},{"code":"320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":555.0,"discounted_cash":277.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Femur 2 Views Lt","code_information":[{"code":"01613550","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Femur 1 View Lt","code_information":[{"code":"01613551","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Knee Two Views Lt","code_information":[{"code":"01613560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Knee - 4 Vws Or More Lt","code_information":[{"code":"01613564","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Knees-Standing Ap","code_information":[{"code":"01613565","type":"CDM"},{"code":"320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Knee Three Views Lt","code_information":[{"code":"01613581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Tibia-Fibula 2 Views Lt","code_information":[{"code":"01613590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Ankle 2 Views Lt","code_information":[{"code":"01613600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Ankle Min 3 Views Lt","code_information":[{"code":"01613610","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Foot 1 View Lt","code_information":[{"code":"01613620","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Foot 3 Or More Views Lt","code_information":[{"code":"01613630","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Foot 2 Views Lt","code_information":[{"code":"01613631","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Oscalcis (Heel) 2+ Views Lt","code_information":[{"code":"01613650","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Toe 2+ Views Lt","code_information":[{"code":"01613660","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"01613809","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ivp","code_information":[{"code":"01614001","type":"CDM"},{"code":"320","type":"RC"},{"code":"74400","type":"HCPCS"}],"standard_charges":[{"gross_charge":950.0,"discounted_cash":475.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Abdomen 2 Views","code_information":[{"code":"01614010","type":"CDM"},{"code":"320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Abdomen 1 View","code_information":[{"code":"01614018","type":"CDM"},{"code":"320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Acute Abdominal","code_information":[{"code":"01614020","type":"CDM"},{"code":"320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Abdomen 3+ Views","code_information":[{"code":"01614021","type":"CDM"},{"code":"320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":520.0,"discounted_cash":260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Wrist W/Carpal Series Lt","code_information":[{"code":"01614110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":190.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray Exam Esophagus Single Cont Inc Scout Films Study","code_information":[{"code":"01614220","type":"CDM"},{"code":"320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Rehab Esophogram","code_information":[{"code":"01614221","type":"CDM"},{"code":"320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Upper Gi Single Contrast W/O Kub","code_information":[{"code":"01614240","type":"CDM"},{"code":"320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Upper Gi Double Contrast W/O Kub","code_information":[{"code":"01614241","type":"CDM"},{"code":"320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.0,"discounted_cash":445.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Sm Int Follow-Thru Study","code_information":[{"code":"01614248","type":"CDM"},{"code":"320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.0,"discounted_cash":425.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Small Bowel Only","code_information":[{"code":"01614250","type":"CDM"},{"code":"320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Colon(Be)","code_information":[{"code":"01614270","type":"CDM"},{"code":"320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Colon Double Contrast","code_information":[{"code":"01614275","type":"CDM"},{"code":"320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Surgical Cholangiogram","code_information":[{"code":"01614300","type":"CDM"},{"code":"320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retrograde Pylogram","code_information":[{"code":"01614431","type":"CDM"},{"code":"320","type":"RC"},{"code":"74420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":860.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cystogram","code_information":[{"code":"01614451","type":"CDM"},{"code":"320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1700.0,"discounted_cash":850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Voiding Cystogram","code_information":[{"code":"01614456","type":"CDM"},{"code":"320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":605.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ankle 1 View Lt","code_information":[{"code":"01614600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"LT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc Hysterosalpingogram","code_information":[{"code":"01614741","type":"CDM"},{"code":"320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.0,"discounted_cash":545.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Intestinal Tube","code_information":[{"code":"01614799","type":"CDM"},{"code":"361","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":957.0,"discounted_cash":478.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Wrist Arthrogram Lt","code_information":[{"code":"01615246","type":"CDM"},{"code":"361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":439.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abdominal Aortogram","code_information":[{"code":"01615628","type":"CDM"},{"code":"320","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6451.0,"discounted_cash":3225.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Angio-Extremities-Unilateral L","code_information":[{"code":"01615712","type":"CDM"},{"code":"320","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":4929.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Angio-Extremities-Bilateral","code_information":[{"code":"01615718","type":"CDM"},{"code":"320","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":7951.0,"discounted_cash":3975.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Venogram Lt Upper Unilat","code_information":[{"code":"01615821","type":"CDM"},{"code":"320","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3011.0,"discounted_cash":1505.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Vena Cavagram  Inferior","code_information":[{"code":"01615826","type":"CDM"},{"code":"320","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":11905.0,"discounted_cash":5952.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Perc Tube Change","code_information":[{"code":"01615984","type":"CDM"},{"code":"320","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluoro For Spinal Inj/Block","code_information":[{"code":"01616000","type":"CDM"},{"code":"320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Contrast Venogram Extre Lt","code_information":[{"code":"01616005","type":"CDM"},{"code":"361","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2007.0,"discounted_cash":1003.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intro Cath Sup/Inf Vena Cava","code_information":[{"code":"01616010","type":"CDM"},{"code":"361","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":385.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Bone Age","code_information":[{"code":"01616020","type":"CDM"},{"code":"320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":283.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Osseous Survey Complete","code_information":[{"code":"01616040","type":"CDM"},{"code":"320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":611.0,"discounted_cash":305.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Osseous Survey Limited","code_information":[{"code":"01616060","type":"CDM"},{"code":"320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.0,"discounted_cash":294.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Int Ndle/Intrcath Extr Bra Art","code_information":[{"code":"01616140","type":"CDM"},{"code":"361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.0,"discounted_cash":471.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Int Ndle/Intrcath Aorta","code_information":[{"code":"01616200","type":"CDM"},{"code":"361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1264.0,"discounted_cash":632.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sel Cath Plmnt Art 3Rd Order","code_information":[{"code":"01616217","type":"CDM"},{"code":"361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":1232.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sel Cath Pl Art 1St Ord Abd/Pe","code_information":[{"code":"01616245","type":"CDM"},{"code":"361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":3000.0,"discounted_cash":1500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sel Cath Pl Art 2Nd Ord Abd/Pe","code_information":[{"code":"01616246","type":"CDM"},{"code":"361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1864.0,"discounted_cash":932.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluoro For Line Placement","code_information":[{"code":"01616321","type":"CDM"},{"code":"320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":214.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Manipulation","code_information":[{"code":"01616493","type":"CDM"},{"code":"361","type":"RC"},{"code":"36597","type":"HCPCS"}],"standard_charges":[{"gross_charge":4076.0,"discounted_cash":2038.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Guidance Vascular Access","code_information":[{"code":"01616937","type":"CDM"},{"code":"402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Guidance","code_information":[{"code":"01616942","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Bone Length Study","code_information":[{"code":"01617040","type":"CDM"},{"code":"320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Manual Stress View","code_information":[{"code":"01617071","type":"CDM"},{"code":"360","type":"RC"},{"code":"77071","type":"HCPCS"}],"standard_charges":[{"gross_charge":366.0,"discounted_cash":183.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Hip Arthrogram Lt","code_information":[{"code":"01617093","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.0,"discounted_cash":498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Knee Arthrogram Lt","code_information":[{"code":"01617370","type":"CDM"},{"code":"361","type":"RC"},{"code":"27369","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.0,"discounted_cash":395.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Esophagus Double Cont Inc Scout Films Study","code_information":[{"code":"01617422","type":"CDM"},{"code":"320","type":"RC"},{"code":"74221","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.0,"discounted_cash":380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Of Elbow 2 Views Lt Ltd","code_information":[{"code":"01618032","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"LT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Ls Spine Flex & Ext Only","code_information":[{"code":"01618120","type":"CDM"},{"code":"320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inj Hysterosalpingogram","code_information":[{"code":"01618340","type":"CDM"},{"code":"361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.0,"discounted_cash":385.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Knee Single View Lt","code_information":[{"code":"01618560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc X-Ray-Spine Single View","code_information":[{"code":"01618606","type":"CDM"},{"code":"320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.0,"discounted_cash":160.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray -Nose-Rectum Fb Child","code_information":[{"code":"01619010","type":"CDM"},{"code":"320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.0,"discounted_cash":180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Elbow 2 Views Lt","code_information":[{"code":"01619070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mod Sed Same Phys/Qhp 5/>Yrs Init 15 Min","code_information":[{"code":"01619152","type":"CDM"},{"code":"370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mod Sed Same Phys/Qhp Ea Add'l 15 Min","code_information":[{"code":"01619153","type":"CDM"},{"code":"370","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.0,"discounted_cash":27.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroid Whole Body Imaging","code_information":[{"code":"01638015","type":"CDM"},{"code":"341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2347.0,"discounted_cash":1173.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Parathyroid Planar Imaging","code_information":[{"code":"01638070","type":"CDM"},{"code":"341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1553.0,"discounted_cash":776.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Parathyrd Planar W/Wo Subtrj W Spect","code_information":[{"code":"01638071","type":"CDM"},{"code":"341","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":1967.0,"discounted_cash":983.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroid Uptake & Scan W/Bld Fl","code_information":[{"code":"01638080","type":"CDM"},{"code":"341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.0,"discounted_cash":950.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Liver Image; Static Only","code_information":[{"code":"01638201","type":"CDM"},{"code":"341","type":"RC"},{"code":"78201","type":"HCPCS"}],"standard_charges":[{"gross_charge":1730.0,"discounted_cash":865.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Liver Imaging (Spect)","code_information":[{"code":"01638205","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":3254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hepatobiliary System Imaging","code_information":[{"code":"01638226","type":"CDM"},{"code":"341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.0,"discounted_cash":972.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hepatobil Syst Image W/Drug","code_information":[{"code":"01638227","type":"CDM"},{"code":"341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":2489.0,"discounted_cash":1244.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Scan - Single Area","code_information":[{"code":"01638300","type":"CDM"},{"code":"341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Scan - Whole Body","code_information":[{"code":"01638306","type":"CDM"},{"code":"341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":1934.0,"discounted_cash":967.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Scan - Three Phase","code_information":[{"code":"01638315","type":"CDM"},{"code":"341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Imaging (Spect)","code_information":[{"code":"01638320","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":3254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Renal Scan","code_information":[{"code":"01638345","type":"CDM"},{"code":"341","type":"RC"},{"code":"78707","type":"HCPCS"}],"standard_charges":[{"gross_charge":2379.0,"discounted_cash":1189.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lung Scan  Perfusion","code_information":[{"code":"01638360","type":"CDM"},{"code":"341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.0,"discounted_cash":950.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gated Heart Study-Single Study","code_information":[{"code":"01638452","type":"CDM"},{"code":"341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gastric Emptying","code_information":[{"code":"01638453","type":"CDM"},{"code":"341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gi Bleeding","code_information":[{"code":"01638460","type":"CDM"},{"code":"341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":978.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Renal Flow With Intervention","code_information":[{"code":"01638463","type":"CDM"},{"code":"341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":2347.0,"discounted_cash":1173.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lung Ventilat&Perfus Imaging","code_information":[{"code":"01638582","type":"CDM"},{"code":"341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":2434.0,"discounted_cash":1217.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Radiopharm Distrib Mult Areas","code_information":[{"code":"01638801","type":"CDM"},{"code":"341","type":"RC"},{"code":"78801","type":"HCPCS"}],"standard_charges":[{"gross_charge":2816.0,"discounted_cash":1408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tumor Localization (Spect)","code_information":[{"code":"01638803","type":"CDM"},{"code":"341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":6508.0,"discounted_cash":3254.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rp Loclzj Tum Spect W/Ct 2","code_information":[{"code":"01638832","type":"CDM"},{"code":"341","type":"RC"},{"code":"78832","type":"HCPCS"}],"standard_charges":[{"gross_charge":7809.0,"discounted_cash":3904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pet Image W/Ct Skull-Thigh St","code_information":[{"code":"01639002","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":6835.0,"discounted_cash":3417.5,"setting":"both","modifiers":"PS","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier PS: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy"}]},{"description":"Hc Pet Imagew/Ct Full Body St","code_information":[{"code":"01639003","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":6835.0,"discounted_cash":3417.5,"setting":"both","modifiers":"PS","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier PS: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy"}]},{"description":"Hc Pet Image W/Ct Full Body In","code_information":[{"code":"01639004","type":"CDM"},{"code":"404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":6835.0,"discounted_cash":3417.5,"setting":"both","modifiers":"PI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier PI: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing"}]},{"description":"Hc Pet Image W/Ct Skull-Thigh In","code_information":[{"code":"01639005","type":"CDM"},{"code":"404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":6835.0,"discounted_cash":3417.5,"setting":"both","modifiers":"PI","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier PI: Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing"}]},{"description":"Hc Heart Scan Spect Multiple","code_information":[{"code":"01639452","type":"CDM"},{"code":"341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":5966.0,"discounted_cash":2983.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Testicular","code_information":[{"code":"01640001","type":"CDM"},{"code":"402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fna Bx W/Us Gdn 1St Les","code_information":[{"code":"01640005","type":"CDM"},{"code":"361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.0,"discounted_cash":1254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fna Bx W/Us Gdn Ea Addl","code_information":[{"code":"01640006","type":"CDM"},{"code":"361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":2444.0,"discounted_cash":1222.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Perc Biopsy Thyroid","code_information":[{"code":"01640100","type":"CDM"},{"code":"361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":2509.0,"discounted_cash":1254.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Aaa Screen","code_information":[{"code":"01640389","type":"CDM"},{"code":"402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Salivary Gland Needle","code_information":[{"code":"01642400","type":"CDM"},{"code":"361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2361.0,"discounted_cash":1180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thoracentesis W/ Imaging","code_information":[{"code":"01642555","type":"CDM"},{"code":"361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":2166.0,"discounted_cash":1083.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transesophageal Echo","code_information":[{"code":"01643312","type":"CDM"},{"code":"483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":2450.0,"discounted_cash":1225.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Ankle/Brachial Index","code_information":[{"code":"01643922","type":"CDM"},{"code":"921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Pulse Vol Record W/O Exer","code_information":[{"code":"01643923","type":"CDM"},{"code":"921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":742.0,"discounted_cash":371.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Color Flow Art Low Ext Bil","code_information":[{"code":"01643925","type":"CDM"},{"code":"921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Color Flow Art Low Ext Uni","code_information":[{"code":"01643926","type":"CDM"},{"code":"921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Color Flow Art Up Ext Bil","code_information":[{"code":"01643928","type":"CDM"},{"code":"921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Color Flow Art Up Ext Uni","code_information":[{"code":"01643931","type":"CDM"},{"code":"921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Venous Reflux Study","code_information":[{"code":"01643965","type":"CDM"},{"code":"921","type":"RC"},{"code":"93998","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":42.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Venous Imaging Up Ext Bil","code_information":[{"code":"01643970","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Venous Imaging Up Ext Uni","code_information":[{"code":"01643971","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Duplex Arterial Flow; Compl","code_information":[{"code":"01643975","type":"CDM"},{"code":"921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":2107.0,"discounted_cash":1053.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Abdominal Doppler Limited","code_information":[{"code":"01643976","type":"CDM"},{"code":"921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":523.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Venous Imaging Lwr Ext Bil","code_information":[{"code":"01643979","type":"CDM"},{"code":"921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.0,"discounted_cash":928.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Pelvic Limited","code_information":[{"code":"01644705","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Duplex Arterial Flow; Limited","code_information":[{"code":"01644976","type":"CDM"},{"code":"921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":523.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Thyroid","code_information":[{"code":"01646530","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Neck Or Head - Soft Tissue","code_information":[{"code":"01646536","type":"CDM"},{"code":"402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ultrasound Breast Complete Lt","code_information":[{"code":"01646641","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1226.0,"discounted_cash":613.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Ultrasound Breast Limited Lt","code_information":[{"code":"01646642","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":450.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc U/S Abdomen Complete","code_information":[{"code":"01646700","type":"CDM"},{"code":"402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Abdomen Limited","code_information":[{"code":"01646705","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":495.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Chest Wall","code_information":[{"code":"01646706","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Pelvic","code_information":[{"code":"01646715","type":"CDM"},{"code":"402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Retroperitoneal Complete","code_information":[{"code":"01646770","type":"CDM"},{"code":"402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Retroperitoneal Limited","code_information":[{"code":"01646775","type":"CDM"},{"code":"402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":486.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Transplanted Kidney","code_information":[{"code":"01646778","type":"CDM"},{"code":"402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity > 14 Weeks Initial Gestation","code_information":[{"code":"01646800","type":"CDM"},{"code":"402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":523.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Spinal Canal/Contents","code_information":[{"code":"01646801","type":"CDM"},{"code":"402","type":"RC"},{"code":"76800","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.0,"discounted_cash":523.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity < 14 Wks Ea Add Gestation","code_information":[{"code":"01646802","type":"CDM"},{"code":"402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":685.0,"discounted_cash":342.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Biophysical Profile","code_information":[{"code":"01646809","type":"CDM"},{"code":"402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":495.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity > 14 Wks Ea Add Gestation","code_information":[{"code":"01646811","type":"CDM"},{"code":"402","type":"RC"},{"code":"76810","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":432.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity Limited 1 Or More Fetus(S)","code_information":[{"code":"01646815","type":"CDM"},{"code":"402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":495.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity Re-Eval Per Fetus","code_information":[{"code":"01646816","type":"CDM"},{"code":"402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Transvaginal Maternity","code_information":[{"code":"01646817","type":"CDM"},{"code":"402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Doppler Umb Artery Fetal","code_information":[{"code":"01646820","type":"CDM"},{"code":"402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Transvaginal Non-Maternity","code_information":[{"code":"01646830","type":"CDM"},{"code":"402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Soft Tissue Pelvis","code_information":[{"code":"01646857","type":"CDM"},{"code":"402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Intra Rectal","code_information":[{"code":"01646873","type":"CDM"},{"code":"402","type":"RC"},{"code":"76872","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.0,"discounted_cash":432.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Extr Non-Vasc Lmtd Lt","code_information":[{"code":"01646880","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":594.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc U/S Infant Hips","code_information":[{"code":"01646885","type":"CDM"},{"code":"402","type":"RC"},{"code":"76885","type":"HCPCS"}],"standard_charges":[{"gross_charge":776.0,"discounted_cash":388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Carotid Doppler Bilateral","code_information":[{"code":"01646900","type":"CDM"},{"code":"921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.0,"discounted_cash":606.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Carotid Doppler Limited","code_information":[{"code":"01646905","type":"CDM"},{"code":"921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":439.0,"discounted_cash":219.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc U/S Cyst/Renal Aspiration","code_information":[{"code":"01646938","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Guidance For Needle Plcmnt","code_information":[{"code":"01646943","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":576.0,"discounted_cash":288.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Perc Liver Biopsy","code_information":[{"code":"01647011","type":"CDM"},{"code":"361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5558.0,"discounted_cash":2779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Soft Tissue Thorax","code_information":[{"code":"01647604","type":"CDM"},{"code":"402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":973.0,"discounted_cash":486.5,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc U/S Soft Tissue Abdomen","code_information":[{"code":"01647705","type":"CDM"},{"code":"402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.0,"discounted_cash":495.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Maternity < 14 Weeks Initial Gestation","code_information":[{"code":"01647801","type":"CDM"},{"code":"402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Bx Or Exc Perc Ln; Superf","code_information":[{"code":"01648505","type":"CDM"},{"code":"361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":5529.0,"discounted_cash":2764.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Perc Breast Asp Cyst","code_information":[{"code":"01649000","type":"CDM"},{"code":"361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2481.0,"discounted_cash":1240.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Drainage - Unlisted","code_information":[{"code":"01649001","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":817.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Biopsy - Unlisted","code_information":[{"code":"01649002","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":817.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abd Paracentesis W/Imaging","code_information":[{"code":"01649083","type":"CDM"},{"code":"361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3594.0,"discounted_cash":1797.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bx Breast,Plcmt Dev Add Lesion Us Imag","code_information":[{"code":"01649084","type":"CDM"},{"code":"361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":2315.0,"discounted_cash":1157.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Muscle Bx; Perc Ndl","code_information":[{"code":"01649206","type":"CDM"},{"code":"361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":5521.0,"discounted_cash":2760.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Venous Imaging Low Ext Uni","code_information":[{"code":"01649642","type":"CDM"},{"code":"921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.0,"discounted_cash":513.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Perc Breast Asp Cyst Ea Ad","code_information":[{"code":"01649901","type":"CDM"},{"code":"361","type":"RC"},{"code":"19001","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.0,"discounted_cash":223.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bx Breast Plcmnt Dev 1St Lesion Us Imag","code_information":[{"code":"01649983","type":"CDM"},{"code":"361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":6247.0,"discounted_cash":3123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Incision & Drainage Hematoma","code_information":[{"code":"01650140","type":"CDM"},{"code":"481","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3373.0,"discounted_cash":1686.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"01651201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.8,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"01651204","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Insertion-Temporary","code_information":[{"code":"01651274","type":"CDM"},{"code":"481","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Cordis Cs Deflectable","code_information":[{"code":"01652206","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4229.6,"discounted_cash":2114.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prq Cardiac Angioplast 1 Art","code_information":[{"code":"01652920","type":"CDM"},{"code":"481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":16278.0,"discounted_cash":8139.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prq Cardiac Angio Addl Art","code_information":[{"code":"01652921","type":"CDM"},{"code":"481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":15879.0,"discounted_cash":7939.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prq Card Revasc Mi 1 Vsl","code_information":[{"code":"01652941","type":"CDM"},{"code":"481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":32802.0,"discounted_cash":16401.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardioversion Electrical","code_information":[{"code":"01652960","type":"CDM"},{"code":"481","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intravascular U/S Initial","code_information":[{"code":"01652978","type":"CDM"},{"code":"480","type":"RC"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intravascular U/S Each Addtnl","code_information":[{"code":"01652979","type":"CDM"},{"code":"480","type":"RC"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":501.0,"discounted_cash":250.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Implant Singl Ventr","code_information":[{"code":"01653207","type":"CDM"},{"code":"481","type":"RC"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":33690.0,"discounted_cash":16845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Repositioning","code_information":[{"code":"01653216","type":"CDM"},{"code":"481","type":"RC"},{"code":"33215","type":"HCPCS"}],"standard_charges":[{"gross_charge":8690.0,"discounted_cash":4345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Insert  Dual Pacer/Defib","code_information":[{"code":"01653217","type":"CDM"},{"code":"481","type":"RC"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Repair Lead Pace-Defib One","code_information":[{"code":"01653218","type":"CDM"},{"code":"481","type":"RC"},{"code":"33218","type":"HCPCS"}],"standard_charges":[{"gross_charge":10774.0,"discounted_cash":5387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Insertion  Biventricular","code_information":[{"code":"01653224","type":"CDM"},{"code":"481","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":37076.0,"discounted_cash":18538.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remv&Replc Pm Gen Singl Lead","code_information":[{"code":"01653227","type":"CDM"},{"code":"481","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remv&Replc Pm Gen Dual Lead","code_information":[{"code":"01653228","type":"CDM"},{"code":"481","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":33690.0,"discounted_cash":16845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Removal  Pacemaker Dual","code_information":[{"code":"01653235","type":"CDM"},{"code":"481","type":"RC"},{"code":"33235","type":"HCPCS"}],"standard_charges":[{"gross_charge":15249.0,"discounted_cash":7624.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator Removal","code_information":[{"code":"01653241","type":"CDM"},{"code":"481","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":9809.0,"discounted_cash":4904.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remv&Replc Cvd Gen Sing Lead","code_information":[{"code":"01653262","type":"CDM"},{"code":"481","type":"RC"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":74598.0,"discounted_cash":37299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remv&Replc Cvd Gen Dual Lead","code_information":[{"code":"01653263","type":"CDM"},{"code":"481","type":"RC"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":74598.0,"discounted_cash":37299.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remv&Replc Cvd Gen Mult Lead","code_information":[{"code":"01653264","type":"CDM"},{"code":"481","type":"RC"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":106021.0,"discounted_cash":53010.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Event Recorder Implant","code_information":[{"code":"01653282","type":"CDM"},{"code":"481","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Rc W/O Coronary Angio","code_information":[{"code":"01653451","type":"CDM"},{"code":"481","type":"RC"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":13962.0,"discounted_cash":6981.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Coronary Art Angio S&I","code_information":[{"code":"01653454","type":"CDM"},{"code":"481","type":"RC"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":9748.0,"discounted_cash":4874.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Cors/Gfts","code_information":[{"code":"01653455","type":"CDM"},{"code":"481","type":"RC"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":9242.0,"discounted_cash":4621.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Right Heart/Cors","code_information":[{"code":"01653456","type":"CDM"},{"code":"481","type":"RC"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":16767.0,"discounted_cash":8383.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Rc/Cors/Gfts","code_information":[{"code":"01653457","type":"CDM"},{"code":"481","type":"RC"},{"code":"93457","type":"HCPCS"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":4682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Lc W/ Coronary Angio","code_information":[{"code":"01653458","type":"CDM"},{"code":"481","type":"RC"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":4682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Lc/Cors/Gfts","code_information":[{"code":"01653459","type":"CDM"},{"code":"481","type":"RC"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":4682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Rlc/Cors","code_information":[{"code":"01653460","type":"CDM"},{"code":"481","type":"RC"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":4682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Rlc/Cors/Gfts","code_information":[{"code":"01653461","type":"CDM"},{"code":"481","type":"RC"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":9364.0,"discounted_cash":4682.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Suprvlv Aortography","code_information":[{"code":"01653567","type":"CDM"},{"code":"481","type":"RC"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.0,"discounted_cash":329.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Ivus","code_information":[{"code":"01654035_122062","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cath Ivus","code_information":[{"code":"01654035","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Generator Removal","code_information":[{"code":"01654233","type":"CDM"},{"code":"481","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Implant Dual A & V","code_information":[{"code":"01655208","type":"CDM"},{"code":"481","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":33690.0,"discounted_cash":16845.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Insertion  Defib","code_information":[{"code":"01655224","type":"CDM"},{"code":"481","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":25122.0,"discounted_cash":12561.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ep Deflect Catheter","code_information":[{"code":"01656464","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iapb Insertion","code_information":[{"code":"01657777","type":"CDM"},{"code":"481","type":"RC"}],"standard_charges":[{"gross_charge":895.0,"discounted_cash":447.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dfr Initial Vessel","code_information":[{"code":"01657780","type":"CDM"},{"code":"481","type":"RC"},{"code":"37780","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"01658543","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.32,"discounted_cash":216.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pericardiocentesis W/Imaging","code_information":[{"code":"01658890","type":"CDM"},{"code":"402","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":10713.0,"discounted_cash":5356.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biventricular Defib Implant","code_information":[{"code":"01659001","type":"CDM"},{"code":"481","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":106021.0,"discounted_cash":53010.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perc Drug-El Cor Stent Sing","code_information":[{"code":"01659600","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":32540.0,"discounted_cash":16270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perc Drug-El Cor Stnt Adl Bran","code_information":[{"code":"01659601","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":37109.0,"discounted_cash":18554.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perc D-E Cor Revasc T Cabg Sin","code_information":[{"code":"01659604","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":32540.0,"discounted_cash":16270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Perc D-E Cor Revasc W Ami Sing","code_information":[{"code":"01659606","type":"CDM"},{"code":"481","type":"RC"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":59977.0,"discounted_cash":29988.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Us Coronary V; Initial","code_information":[{"code":"01659978","type":"CDM"},{"code":"481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":1951.0,"discounted_cash":975.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fna Bx W/Ct Gdn 1St Les","code_information":[{"code":"01660009","type":"CDM"},{"code":"361","type":"RC"},{"code":"10009","type":"HCPCS"}],"standard_charges":[{"gross_charge":2369.0,"discounted_cash":1184.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Limited Sinus Wo Contr","code_information":[{"code":"01660016","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":539.0,"setting":"both","modifiers":"52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 52: Reduced Services"}]},{"description":"Hc Ct Guided Cathet Fluid Drainage Percutaneous","code_information":[{"code":"01660030","type":"CDM"},{"code":"361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2518.0,"discounted_cash":1259.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drainage Catheter","code_information":[{"code":"01660061","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Smart Lung Ct Scan","code_information":[{"code":"01660125","type":"CDM"},{"code":"352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":78.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Biopsy Kidney","code_information":[{"code":"01660200","type":"CDM"},{"code":"361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":5558.0,"discounted_cash":2779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Biopsy Bone Tr/Ndl; Superf","code_information":[{"code":"01660220","type":"CDM"},{"code":"361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":2630.0,"discounted_cash":1315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Biopsy Deep Bone Trcr/Ndl","code_information":[{"code":"01660225","type":"CDM"},{"code":"361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":5558.0,"discounted_cash":2779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Head Scan W/O Contrast","code_information":[{"code":"01660450","type":"CDM"},{"code":"351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.0,"discounted_cash":636.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Iac W/O Contrast","code_information":[{"code":"01660452","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Face W/O Contrast","code_information":[{"code":"01660453","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Neck W/O Contrast","code_information":[{"code":"01660455","type":"CDM"},{"code":"351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Head Scan W/Contrast","code_information":[{"code":"01660460","type":"CDM"},{"code":"351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":2011.0,"discounted_cash":1005.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Iac W/Contrast","code_information":[{"code":"01660462","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.0,"discounted_cash":907.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Face W/Contrast","code_information":[{"code":"01660463","type":"CDM"},{"code":"351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":1633.0,"discounted_cash":816.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Neck W/Contrast","code_information":[{"code":"01660465","type":"CDM"},{"code":"351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1687.0,"discounted_cash":843.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Head Scan W/Wo Contrast","code_information":[{"code":"01660470","type":"CDM"},{"code":"351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2047.0,"discounted_cash":1023.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Iac W/Wo Contrast","code_information":[{"code":"01660472","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1230.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Face W/Wo Contrast","code_information":[{"code":"01660473","type":"CDM"},{"code":"351","type":"RC"},{"code":"70488","type":"HCPCS"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":1220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Neck W/Wo Contrast","code_information":[{"code":"01660475","type":"CDM"},{"code":"351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1743.0,"discounted_cash":871.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Orbit W/O Contrast","code_information":[{"code":"01660480","type":"CDM"},{"code":"351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":1096.0,"discounted_cash":548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Orbit W/Contrast","code_information":[{"code":"01660481","type":"CDM"},{"code":"351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1814.0,"discounted_cash":907.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Orbit W/Wo Contrast","code_information":[{"code":"01660482","type":"CDM"},{"code":"351","type":"RC"},{"code":"70482","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.0,"discounted_cash":1230.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Sinus Coronally Wo Contrast","code_information":[{"code":"01660486","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Sinus Axially W/O Contrast","code_information":[{"code":"01660487","type":"CDM"},{"code":"351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta-Head","code_information":[{"code":"01660496","type":"CDM"},{"code":"351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":888.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta-Neck","code_information":[{"code":"01660498","type":"CDM"},{"code":"351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":1777.0,"discounted_cash":888.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Chest W/O Contrast","code_information":[{"code":"01661250","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Chest-High Resolution","code_information":[{"code":"01661253","type":"CDM"},{"code":"352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Chest W/Contrast","code_information":[{"code":"01661260","type":"CDM"},{"code":"352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Chest W/Wo Contrast","code_information":[{"code":"01661270","type":"CDM"},{"code":"352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":1043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta-Chest","code_information":[{"code":"01661275","type":"CDM"},{"code":"352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1098.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Chest Tube Placement","code_information":[{"code":"01662020","type":"CDM"},{"code":"361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":3587.0,"discounted_cash":1793.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Cervical Spine W/Contrast","code_information":[{"code":"01662126","type":"CDM"},{"code":"352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":3195.0,"discounted_cash":1597.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Cervical Spine W/Wo Con","code_information":[{"code":"01662127","type":"CDM"},{"code":"352","type":"RC"},{"code":"72127","type":"HCPCS"}],"standard_charges":[{"gross_charge":2441.0,"discounted_cash":1220.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Thoracic Spine W/Contrast","code_information":[{"code":"01662129","type":"CDM"},{"code":"352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":2044.0,"discounted_cash":1022.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Thoracic Spine W/Wo Contrst","code_information":[{"code":"01662130","type":"CDM"},{"code":"352","type":"RC"},{"code":"72130","type":"HCPCS"}],"standard_charges":[{"gross_charge":2855.0,"discounted_cash":1427.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Lumbar Spine-Strght W/Con","code_information":[{"code":"01662132","type":"CDM"},{"code":"352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3912.0,"discounted_cash":1956.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Lumbar Spine-Strt W/Wo Con","code_information":[{"code":"01662133","type":"CDM"},{"code":"352","type":"RC"},{"code":"72133","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.0,"discounted_cash":1033.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Lumbar Spine-Strght W/O Con","code_information":[{"code":"01662146","type":"CDM"},{"code":"352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.0,"discounted_cash":670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Cervical Spine W/O Contrast","code_information":[{"code":"01662148","type":"CDM"},{"code":"352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":1078.0,"discounted_cash":539.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Thoracic Spine W/O Contrast","code_information":[{"code":"01662149","type":"CDM"},{"code":"352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Pelvis W/O Contrast","code_information":[{"code":"01662192","type":"CDM"},{"code":"352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Pelvis W/Contrast","code_information":[{"code":"01662193","type":"CDM"},{"code":"352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":1043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Pelvis W/Wo Contrast","code_information":[{"code":"01662194","type":"CDM"},{"code":"352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1054.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Core Ndl Bx Lng/Med Perq Ct Guidance","code_information":[{"code":"01662408","type":"CDM"},{"code":"361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":6144.0,"discounted_cash":3072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Upper Ext W/O Contrast Lt","code_information":[{"code":"01663200","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":780.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Ct Upper Ext W/Contrast Lt","code_information":[{"code":"01663201","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4833.0,"discounted_cash":2416.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Cta-Upper Extremity Left","code_information":[{"code":"01663206","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2569.0,"discounted_cash":1284.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Ct Lower Ext W/O Contrast Lt","code_information":[{"code":"01663700","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Ct Lower Ext W/Contrast Lt","code_information":[{"code":"01663701","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.0,"discounted_cash":1230.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Cta-Lower Extremity Left","code_information":[{"code":"01663706","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3186.0,"discounted_cash":1593.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Ct Abdomen W/O Contrast","code_information":[{"code":"01664150","type":"CDM"},{"code":"352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abdomen W Contrast","code_information":[{"code":"01664160","type":"CDM"},{"code":"352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2086.0,"discounted_cash":1043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abdomen W/Wo Contrast","code_information":[{"code":"01664170","type":"CDM"},{"code":"352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":2131.0,"discounted_cash":1065.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Pancreas W/Wo Contrast","code_information":[{"code":"01664172","type":"CDM"},{"code":"352","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abd & Pelvis W/O Contrast","code_information":[{"code":"01664176","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abd & Pelvis  W/Contrast","code_information":[{"code":"01664177","type":"CDM"},{"code":"352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":4570.0,"discounted_cash":2285.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abd & Pelvis W/Wo Contrast","code_information":[{"code":"01664178","type":"CDM"},{"code":"352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":4657.0,"discounted_cash":2328.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta-Abdomen","code_information":[{"code":"01665175","type":"CDM"},{"code":"352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":2197.0,"discounted_cash":1098.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta-Aorta/Bilateral Legs","code_information":[{"code":"01665635","type":"CDM"},{"code":"352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":1955.0,"discounted_cash":977.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Guide Biopsy Comp","code_information":[{"code":"01666361","type":"CDM"},{"code":"352","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Guide Cyst Asp","code_information":[{"code":"01666366","type":"CDM"},{"code":"352","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct 3D Recon W/O Post Process","code_information":[{"code":"01666376","type":"CDM"},{"code":"352","type":"RC"},{"code":"76376","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Biopsy Liver","code_information":[{"code":"01667000","type":"CDM"},{"code":"361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":5558.0,"discounted_cash":2779.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Guided Injection","code_information":[{"code":"01667361","type":"CDM"},{"code":"352","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":1715.0,"discounted_cash":857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Limited Or Follow-Up Scan","code_information":[{"code":"01667380","type":"CDM"},{"code":"350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":988.0,"discounted_cash":494.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Biopsy - Unlisted","code_information":[{"code":"01669000","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":3127.0,"discounted_cash":1563.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Drainage - Unlisted","code_information":[{"code":"01669001","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":2893.0,"discounted_cash":1446.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cta Abdomen & Pelvis","code_information":[{"code":"01669174","type":"CDM"},{"code":"352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":4284.0,"discounted_cash":2142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Abd & Pelv/Stone W/O Contr","code_information":[{"code":"01669176","type":"CDM"},{"code":"352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":2835.0,"discounted_cash":1417.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ct Guided Cath Fluid Peri/Retro","code_information":[{"code":"01669406","type":"CDM"},{"code":"361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":6217.0,"discounted_cash":3108.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heart Smart Ct","code_information":[{"code":"01669971","type":"CDM"},{"code":"350","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.0,"discounted_cash":78.0,"setting":"both","modifiers":"GY","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GY: Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit"}]},{"description":"Hc Bedded Outpatient Initial Hour","code_information":[{"code":"01681006","type":"CDM"},{"code":"762","type":"RC"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bedded Outpatient Each Additional Hour","code_information":[{"code":"01681007","type":"CDM"},{"code":"762","type":"RC"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Central Line Insertion","code_information":[{"code":"01682005","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":956.0,"discounted_cash":478.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Chest Tube Insertion","code_information":[{"code":"01682006","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":5649.0,"discounted_cash":2824.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foley Catheter Insertion","code_information":[{"code":"01682018","type":"CDM"},{"code":"361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardioversion Electrical","code_information":[{"code":"01682024","type":"CDM"},{"code":"481","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":2156.0,"discounted_cash":1078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc I & D Abscess","code_information":[{"code":"01682027","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extend Recovery Init'l Hour","code_information":[{"code":"01684545","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":258.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extend Recovery Ea Add Hour","code_information":[{"code":"01684546","type":"CDM"},{"code":"710","type":"RC"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Blood Transfusion","code_information":[{"code":"01686660","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Therapies","code_information":[{"code":"01686661","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Picc Line Insertion","code_information":[{"code":"01686662","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Infusion","code_information":[{"code":"01686663","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Ekg Eeg","code_information":[{"code":"01686664","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Ct","code_information":[{"code":"01686665","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Mri","code_information":[{"code":"01686666","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Us","code_information":[{"code":"01686667","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Rad Oncology","code_information":[{"code":"01686668","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Pft & Respiratory","code_information":[{"code":"01686669","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Nuc Med","code_information":[{"code":"01686670","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Nutrition & Diabetes","code_information":[{"code":"01686675","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Radiology","code_information":[{"code":"01686676","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Echo","code_information":[{"code":"01686677","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Carve-Out Hemodialysis","code_information":[{"code":"01686678","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinalysis W/Microscop Non-Auto","code_information":[{"code":"01687783","type":"CDM"},{"code":"300","type":"RC"},{"code":"81000","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Initial Hour Da","code_information":[{"code":"01688100","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Admin Influenza Vaccine","code_information":[{"code":"01689111","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0008","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Admin Pneumococcal Vaccine","code_information":[{"code":"01689112","type":"CDM"},{"code":"771","type":"RC"},{"code":"G0009","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunization Admin- 1 Vac","code_information":[{"code":"01689115","type":"CDM"},{"code":"771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immun Admin Ea Add","code_information":[{"code":"01689116","type":"CDM"},{"code":"771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iv Inf Hyd Ea Add 31-60 Min","code_information":[{"code":"01689202","type":"CDM"},{"code":"260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","modifiers":"NC|VD","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier NC: Modifier description not available | Modifier VD: Modifier description not available"}]},{"description":"Hc Observation Each Addtnl Hour","code_information":[{"code":"01689998","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Observation Initial Hour","code_information":[{"code":"01689999","type":"CDM"},{"code":"762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":586.0,"discounted_cash":293.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Post Op Pain Block W/Img Guid","code_information":[{"code":"01695555","type":"CDM"},{"code":"361","type":"RC"}],"standard_charges":[{"gross_charge":2104.0,"discounted_cash":1052.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc U/S Guided Needle Placement","code_information":[{"code":"01696937","type":"CDM"},{"code":"402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oxygen Per Day","code_information":[{"code":"01700501_271","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":39.11,"discounted_cash":19.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Oxygen Per Day","code_information":[{"code":"01700501","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intubation","code_information":[{"code":"01701287","type":"CDM"},{"code":"361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.0,"discounted_cash":350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Metered Dose Inhaler","code_information":[{"code":"01701292","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oximeter Overnight","code_information":[{"code":"01701408","type":"CDM"},{"code":"460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mechanical Vent 1St Day","code_information":[{"code":"01701421","type":"CDM"},{"code":"410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":591.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bronchospasm Eval; Spirometry","code_information":[{"code":"01704060","type":"CDM"},{"code":"460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pep Therapy","code_information":[{"code":"01704640","type":"CDM"},{"code":"410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.0,"discounted_cash":236.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cpap-Bipap Per Day","code_information":[{"code":"01704660","type":"CDM"},{"code":"410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cppd - Subsequent","code_information":[{"code":"01704668","type":"CDM"},{"code":"410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulm Funct Tst Plethysmograp","code_information":[{"code":"01704726","type":"CDM"},{"code":"460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.0,"discounted_cash":387.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C0 Diffuse Capacity","code_information":[{"code":"01704729","type":"CDM"},{"code":"460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.0,"discounted_cash":91.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mechanical Vent Sub Days","code_information":[{"code":"01706457","type":"CDM"},{"code":"410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":1182.0,"discounted_cash":591.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cppd - Initial","code_information":[{"code":"01706476","type":"CDM"},{"code":"410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.0,"discounted_cash":139.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Aerosol","code_information":[{"code":"01706479","type":"CDM"},{"code":"410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.0,"discounted_cash":241.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Incentive Spirometry","code_information":[{"code":"01706481","type":"CDM"},{"code":"410","type":"RC"},{"code":"94799","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiopulmonary Resuscitation","code_information":[{"code":"01706484","type":"CDM"},{"code":"480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.0,"discounted_cash":559.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abg Draw","code_information":[{"code":"01706485","type":"CDM"},{"code":"300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pft Spirometry","code_information":[{"code":"01706489","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flow Volume Loop","code_information":[{"code":"01706491","type":"CDM"},{"code":"460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.0,"discounted_cash":204.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arterial Draw /Rt","code_information":[{"code":"01707779","type":"CDM"},{"code":"410","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":297.0,"discounted_cash":148.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carboxyhgb Qnt","code_information":[{"code":"01707780","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ph Blood","code_information":[{"code":"01707781","type":"CDM"},{"code":"300","type":"RC"},{"code":"82800","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abg W/O2 Sat Meas","code_information":[{"code":"01707783","type":"CDM"},{"code":"300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Newborn Resuscitation","code_information":[{"code":"01709440","type":"CDM"},{"code":"480","type":"RC"},{"code":"99465","type":"HCPCS"}],"standard_charges":[{"gross_charge":1540.0,"discounted_cash":770.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oximeter Single Determination","code_information":[{"code":"01709887","type":"CDM"},{"code":"460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Volume Studies","code_information":[{"code":"01709889","type":"CDM"},{"code":"460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.0,"discounted_cash":220.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dry Needle Insj W/O Njx 1 Or 2 Musc","code_information":[{"code":"01720560","type":"CDM"},{"code":"420","type":"RC"},{"code":"20560","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Dry Needle Insj W/O Njx 3+ Musc","code_information":[{"code":"01720561","type":"CDM"},{"code":"420","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Unil App Multi Compress Low Leg; Ankle/Foot Pt","code_information":[{"code":"01722006","type":"CDM"},{"code":"420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Bil App Compress Low Leg; Ankle/Foot Pt","code_information":[{"code":"01722010","type":"CDM"},{"code":"420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":466.0,"discounted_cash":233.0,"setting":"both","modifiers":"50|GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Canalith Procedure - Pt","code_information":[{"code":"01722016","type":"CDM"},{"code":"420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.0,"discounted_cash":70.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Eval Low Complex 20 Min","code_information":[{"code":"01727161","type":"CDM"},{"code":"424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":174.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Eval Mod Complex 30 Min","code_information":[{"code":"01727162","type":"CDM"},{"code":"424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":174.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Eval High Complex 45 Min","code_information":[{"code":"01727163","type":"CDM"},{"code":"424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.0,"discounted_cash":174.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Re-Eval Est Plan Care","code_information":[{"code":"01727164","type":"CDM"},{"code":"424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.0,"discounted_cash":126.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Massage Manual Thpy 15Min","code_information":[{"code":"01727778","type":"CDM"},{"code":"949","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.0,"discounted_cash":21.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adl/Self Care/15 Min-Pt","code_information":[{"code":"01728000","type":"CDM"},{"code":"420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Aquatic Therapy/15 Min-Pt","code_information":[{"code":"01728002","type":"CDM"},{"code":"420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":90.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Cold Pack-Pt","code_information":[{"code":"01728008","type":"CDM"},{"code":"420","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.0,"discounted_cash":26.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc E Stim:Manual/15 Min-Pt","code_information":[{"code":"01728022","type":"CDM"},{"code":"420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Elect Stim (Unattended)-Pt","code_information":[{"code":"01728024","type":"CDM"},{"code":"420","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":32.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Gait Training/15 Min-Pt","code_information":[{"code":"01728036","type":"CDM"},{"code":"420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Iontophoresis/15 Min-Pt","code_information":[{"code":"01728045","type":"CDM"},{"code":"420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Manual Therapy/15 Min-Pt","code_information":[{"code":"01728046","type":"CDM"},{"code":"420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Massage/15 Min-Pt","code_information":[{"code":"01728048","type":"CDM"},{"code":"420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Neuromuscle Re-Ed/15 Min-Pt","code_information":[{"code":"01728055","type":"CDM"},{"code":"420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":83.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Orthotic Mgmt&Trainj 1St Enc /15 Min","code_information":[{"code":"01728060","type":"CDM"},{"code":"420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":104.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Phys Perf Test W/Rpt-15 Min-Pt","code_information":[{"code":"01728064","type":"CDM"},{"code":"420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":83.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Prosthetic Trainj 1St Enc /15 Min","code_information":[{"code":"01728065","type":"CDM"},{"code":"420","type":"RC"},{"code":"97761","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Therapeutic Activ/15 Min-Pt","code_information":[{"code":"01728077","type":"CDM"},{"code":"420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.0,"discounted_cash":90.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Ther Exercise/15 Min-Pt","code_information":[{"code":"01728078","type":"CDM"},{"code":"420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Traction Mechanical-Pt","code_information":[{"code":"01728084","type":"CDM"},{"code":"420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Ultrasound/15 Min-Pt","code_information":[{"code":"01728087","type":"CDM"},{"code":"420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Vasopneumatic Devices-Pt","code_information":[{"code":"01728088","type":"CDM"},{"code":"420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Wheelchair Mgmt/Trn/15 Min-Pt","code_information":[{"code":"01728089","type":"CDM"},{"code":"420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":62.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Pt Orthc/Prostc Mgmt Sbsq Enc /15 Min","code_information":[{"code":"01728094","type":"CDM"},{"code":"420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GP: Services delivered under an outpatient physical therapy plan of care"}]},{"description":"Hc Cognitive Perf Eval Stnd - Ot","code_information":[{"code":"01732006","type":"CDM"},{"code":"430","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":217.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ther Ivntj Cog Funcj Cntct 1St 15 Min - Ot","code_information":[{"code":"01737129","type":"CDM"},{"code":"430","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ther Ivntj Cog Funcj Cntct Ea Add'l 15 Min - Ot","code_information":[{"code":"01737130","type":"CDM"},{"code":"430","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Eval Low Complex 30 Min","code_information":[{"code":"01737165","type":"CDM"},{"code":"434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Eval Mod Complex 45 Min","code_information":[{"code":"01737166","type":"CDM"},{"code":"434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Eval High Complex 60 Min","code_information":[{"code":"01737167","type":"CDM"},{"code":"434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Re-Eval Est Plan Care","code_information":[{"code":"01737168","type":"CDM"},{"code":"434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.0,"discounted_cash":132.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Adl/Self Care/15 Min-Ot","code_information":[{"code":"01738000","type":"CDM"},{"code":"430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Contrast Bath/15 Min-Ot","code_information":[{"code":"01738012","type":"CDM"},{"code":"430","type":"RC"},{"code":"97034","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc E Stim:Manual/15 Min-Ot","code_information":[{"code":"01738017","type":"CDM"},{"code":"430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.0,"discounted_cash":42.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Elec Stim (Unattended)-Ot","code_information":[{"code":"01738018","type":"CDM"},{"code":"430","type":"RC"},{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Fluidotherapy-Ot","code_information":[{"code":"01738026","type":"CDM"},{"code":"430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Manual Therapy/15 Min-Ot","code_information":[{"code":"01738033","type":"CDM"},{"code":"430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":62.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Massage/15 Min-Ot","code_information":[{"code":"01738035","type":"CDM"},{"code":"430","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Neuromuscle Re-Ed/15 Min-Ot","code_information":[{"code":"01738041","type":"CDM"},{"code":"430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Iontophoresis/15 Min-Ot","code_information":[{"code":"01738045","type":"CDM"},{"code":"430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Orthc/Prostc Mgmt Sbsq Enc /15 Min","code_information":[{"code":"01738049","type":"CDM"},{"code":"430","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.0,"discounted_cash":86.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ot Orthotic Mgmt&Trainj 1St Enc /15 Min","code_information":[{"code":"01738050","type":"CDM"},{"code":"430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.0,"discounted_cash":97.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Paraffin Bath-Ot","code_information":[{"code":"01738060","type":"CDM"},{"code":"430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Phys Perf Test W/Rpt-15 Min-Ot","code_information":[{"code":"01738062","type":"CDM"},{"code":"430","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Sensory Integration/15 Min-Ot","code_information":[{"code":"01738067","type":"CDM"},{"code":"430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":83.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Splint; Short Arm Static-Ot","code_information":[{"code":"01738076","type":"CDM"},{"code":"430","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":178.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ther Exercise/15 Min-Ot","code_information":[{"code":"01738080","type":"CDM"},{"code":"430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.0,"discounted_cash":69.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ther Activities/15 Min-Ot","code_information":[{"code":"01738087","type":"CDM"},{"code":"430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Ultrasound/15 Min-Ot","code_information":[{"code":"01738089","type":"CDM"},{"code":"430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Wheelchair Mgmt/Trn/15 Min-Ot","code_information":[{"code":"01738090","type":"CDM"},{"code":"430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":62.5,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Aquatic Therapy/15 Min-Ot","code_information":[{"code":"01738202","type":"CDM"},{"code":"430","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":166.0,"discounted_cash":83.0,"setting":"both","modifiers":"GO","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care"}]},{"description":"Hc Laryngoscopy Flex Or Rigid W Stroboscopy","code_information":[{"code":"01741579","type":"CDM"},{"code":"441","type":"RC"},{"code":"31579","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":585.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Indiv Therapy - Sp","code_information":[{"code":"01742507","type":"CDM"},{"code":"440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":334.0,"discounted_cash":167.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Dysphagia Treatment - Sp","code_information":[{"code":"01742526","type":"CDM"},{"code":"440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Sp Gen Device Aac Tx","code_information":[{"code":"01742609","type":"CDM"},{"code":"440","type":"RC"},{"code":"92609","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":191.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Clinicl Swallow Eval - Sp","code_information":[{"code":"01742610","type":"CDM"},{"code":"440","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.0,"discounted_cash":159.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Rehab Swallow Study Non Recorded (Mbs)-Sp","code_information":[{"code":"01742700","type":"CDM"},{"code":"440","type":"RC"},{"code":"92700","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":145.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Cognitive Test By Hc Pro Per Hour","code_information":[{"code":"01746125","type":"CDM"},{"code":"440","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":435.0,"discounted_cash":217.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Ther Ivntj Cog Funcj Cntct 1St 15 Min - Sp","code_information":[{"code":"01747129","type":"CDM"},{"code":"440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Ther Ivntj Cog Funcj Cntct Ea Add'l 15 Min - Sp","code_information":[{"code":"01747130","type":"CDM"},{"code":"440","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Evaluation Of Speech Fluency - Sp","code_information":[{"code":"01747521","type":"CDM"},{"code":"444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":464.0,"discounted_cash":232.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Aphasia Test W/Rpt/60 Min-Sp","code_information":[{"code":"01748007","type":"CDM"},{"code":"440","type":"RC"},{"code":"96105","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Eval Sp Gen Device/Initl Hr-Sp","code_information":[{"code":"01748037","type":"CDM"},{"code":"444","type":"RC"},{"code":"92607","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":239.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Rehab Swallow Study (Mbs)-Sp","code_information":[{"code":"01748069","type":"CDM"},{"code":"440","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":188.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Eval Behavral Qualit Analys Voice - Sp","code_information":[{"code":"01749070","type":"CDM"},{"code":"444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":188.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Evaluate Speech Production - Sp","code_information":[{"code":"01749072","type":"CDM"},{"code":"444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":188.5,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Eval Speech Sound Lang Comprehen - Sp","code_information":[{"code":"01749075","type":"CDM"},{"code":"444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":385.0,"setting":"both","modifiers":"GN","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GN: Services delivered under an outpatient speech language pathology plan of care"}]},{"description":"Hc Enteroscopy","code_information":[{"code":"01790062","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anascopy","code_information":[{"code":"01790103","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ileoscopy","code_information":[{"code":"01790104","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":3036.0,"discounted_cash":1518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Spec Procedure-Simple","code_information":[{"code":"01790970","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":538.0,"discounted_cash":269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Spec Procedure-Complex","code_information":[{"code":"01790971","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":1358.0,"discounted_cash":679.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bravo Ph Monitoring-48 Hours","code_information":[{"code":"01791035","type":"CDM"},{"code":"750","type":"RC"},{"code":"91035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1733.0,"discounted_cash":866.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gastroscopy","code_information":[{"code":"01795130","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Colonoscopy","code_information":[{"code":"01795131","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rigid Sigmoidoscopy","code_information":[{"code":"01796593","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoscopy Spec Proc-Moderate","code_information":[{"code":"01796595","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":961.0,"discounted_cash":480.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bronchoscopy","code_information":[{"code":"01796642","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Esophageal Motility","code_information":[{"code":"01797903","type":"CDM"},{"code":"750","type":"RC"},{"code":"91010","type":"HCPCS"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flexible Sigmoidoscopy","code_information":[{"code":"01798128","type":"CDM"},{"code":"360","type":"RC"}],"standard_charges":[{"gross_charge":2831.0,"discounted_cash":1415.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc I&D Absc; Smpl Or Sgl","code_information":[{"code":"01890060","type":"CDM"},{"code":"761","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.0,"discounted_cash":239.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trimming - Dystrophic Nails","code_information":[{"code":"01890127","type":"CDM"},{"code":"761","type":"RC"},{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Deb Subq Tissue 20 Sq Cm/<","code_information":[{"code":"01891042","type":"CDM"},{"code":"761","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":437.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Deb Subq Tissue Add-On =<20 Sq Cm","code_information":[{"code":"01891045","type":"CDM"},{"code":"761","type":"RC"},{"code":"11045","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":60.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pare Benign Les; Sgl","code_information":[{"code":"01891055","type":"CDM"},{"code":"761","type":"RC"},{"code":"11055","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trim Skin Lesions 2 To 4","code_information":[{"code":"01891056","type":"CDM"},{"code":"761","type":"RC"},{"code":"11056","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Punch Bx Skin Single Lesion","code_information":[{"code":"01891104","type":"CDM"},{"code":"761","type":"RC"},{"code":"11104","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":437.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trimming - Nondystrophic Nails","code_information":[{"code":"01891719","type":"CDM"},{"code":"761","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc I&D Hematoma/Fluid","code_information":[{"code":"01892140","type":"CDM"},{"code":"761","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":3504.0,"discounted_cash":1752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Skin Sub Graft Trnk/Arm/Leg","code_information":[{"code":"01895271","type":"CDM"},{"code":"761","type":"RC"},{"code":"15271","type":"HCPCS"}],"standard_charges":[{"gross_charge":4712.0,"discounted_cash":2356.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dress/Debrid P-Thick Burn S","code_information":[{"code":"01896020","type":"CDM"},{"code":"761","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":688.0,"discounted_cash":344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chem Caut Granulation Tiss","code_information":[{"code":"01897250","type":"CDM"},{"code":"761","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.0,"discounted_cash":377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Debridement-Selective < 20 Sq Cm","code_information":[{"code":"01897597","type":"CDM"},{"code":"761","type":"RC"},{"code":"97597","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":161.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neg Press Wound Tx < 50 Cm","code_information":[{"code":"01897605","type":"CDM"},{"code":"761","type":"RC"},{"code":"97605","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":228.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neg Press Wound Tx > 50 Cm","code_information":[{"code":"01897606","type":"CDM"},{"code":"761","type":"RC"},{"code":"97606","type":"HCPCS"}],"standard_charges":[{"gross_charge":762.0,"discounted_cash":381.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Disposable Neg Press Wound Tx <=50 Sq Cm","code_information":[{"code":"01897607","type":"CDM"},{"code":"761","type":"RC"},{"code":"97607","type":"HCPCS"}],"standard_charges":[{"gross_charge":874.0,"discounted_cash":437.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drs&/Dbrdmt Prtl-Thkns Burns 1St/Sbsq Small","code_information":[{"code":"01898888","type":"CDM"},{"code":"761","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.0,"discounted_cash":232.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Apply Rigid Total Contact Leg Cast","code_information":[{"code":"01899445","type":"CDM"},{"code":"761","type":"RC"},{"code":"29445","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.0,"discounted_cash":306.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Unna Boot Strapping - Rt","code_information":[{"code":"01899580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":382.0,"discounted_cash":191.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Multlay Comprs Lwr Leg-Rt","code_information":[{"code":"01899581","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Sizer Mammary","code_information":[{"code":"02330002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gastrostomy Button 24Fr 1.2Cm","code_information":[{"code":"02330030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":755.01,"discounted_cash":377.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330180","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3503.43,"discounted_cash":1751.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330182","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":11399.3,"discounted_cash":5699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330184","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":15541.19,"discounted_cash":7770.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02330242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30772.0,"discounted_cash":15386.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5505.82,"discounted_cash":2752.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heart Valve","code_information":[{"code":"02330301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":23600.0,"discounted_cash":11800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Accessory Kit","code_information":[{"code":"02330307","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":71182.34,"discounted_cash":35591.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4069.26,"discounted_cash":2034.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02330317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8424.45,"discounted_cash":4212.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Bar Locking","code_information":[{"code":"02330435","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Sleeve Dall","code_information":[{"code":"02330663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2718.76,"discounted_cash":1359.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Sleeve Dall","code_information":[{"code":"02330697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1558.81,"discounted_cash":779.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Coil Dall","code_information":[{"code":"02330703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2230.36,"discounted_cash":1115.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Richards Staple","code_information":[{"code":"02330707","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.15,"discounted_cash":923.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02330745_33787","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02330745_36273","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02330745_52042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02330745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aneurysm Clip","code_information":[{"code":"02331109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3690.68,"discounted_cash":1845.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Apex","code_information":[{"code":"02331152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1346.8,"discounted_cash":673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Locking Ring","code_information":[{"code":"02331160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2553.0,"discounted_cash":1276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteotome","code_information":[{"code":"02331241_122063","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3581.6,"discounted_cash":1790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Osteotome","code_information":[{"code":"02331241_127918","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3581.6,"discounted_cash":1790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Osteotome","code_information":[{"code":"02331241","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3581.6,"discounted_cash":1790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteotome","code_information":[{"code":"02331242","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6528.0,"discounted_cash":3264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02331264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":10828.35,"discounted_cash":5414.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Combo Clamp","code_information":[{"code":"02331676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4066.33,"discounted_cash":2033.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Universal Clamp","code_information":[{"code":"02331679","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5897.64,"discounted_cash":2948.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02331681","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":758.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02331682_130521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1633.33,"discounted_cash":816.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02331682_130522","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1633.33,"discounted_cash":816.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02331682","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1633.33,"discounted_cash":816.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02331686","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1906.76,"discounted_cash":953.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02331694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28320.0,"discounted_cash":14160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Duraflo","code_information":[{"code":"02331697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":17700.0,"discounted_cash":8850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Duragaurd 6Cmx8Cm","code_information":[{"code":"02331856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4035.53,"discounted_cash":2017.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Washerloc","code_information":[{"code":"02331880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sleeve Centering","code_information":[{"code":"02332235","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endopath Linear Cutter Reload","code_information":[{"code":"02332265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02332270_43713","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.6,"discounted_cash":458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02332270","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.6,"discounted_cash":458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Ethicon Ez10G","code_information":[{"code":"02332273_31068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1028.97,"discounted_cash":514.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Ethicon Ez10G","code_information":[{"code":"02332273","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":971.84,"discounted_cash":485.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02332295_130520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1122.14,"discounted_cash":561.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02332295","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1122.14,"discounted_cash":561.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Linear Reload Tr45B","code_information":[{"code":"02332329","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Grasper - Babcock","code_information":[{"code":"02332337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":982.72,"discounted_cash":491.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02332402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Pin Set","code_information":[{"code":"02332404_110873","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.65,"discounted_cash":396.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Pin Set","code_information":[{"code":"02332404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":793.65,"discounted_cash":396.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Curved","code_information":[{"code":"02332427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5669.79,"discounted_cash":2834.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgicel Nu-Knit (Ethicon)","code_information":[{"code":"02332486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":889.21,"discounted_cash":444.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02332569_128385","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.85,"discounted_cash":223.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02332569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":452.68,"discounted_cash":226.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Neuro Delta 1.5","code_information":[{"code":"02332597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13249.73,"discounted_cash":6624.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passer","code_information":[{"code":"02332774_112771","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer","code_information":[{"code":"02332774_127238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer","code_information":[{"code":"02332774_31068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer","code_information":[{"code":"02332774_34960","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer","code_information":[{"code":"02332774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heart Valve","code_information":[{"code":"02332800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29792.0,"discounted_cash":14896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfix Clamp Wire/Pin","code_information":[{"code":"02332954","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5243.62,"discounted_cash":2621.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Neurostimulator","code_information":[{"code":"02333012_127315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Neurostimulator","code_information":[{"code":"02333012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Universal Clamp 6-Pos","code_information":[{"code":"02333150","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4650.25,"discounted_cash":2325.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Silo Bag 7.5 Cm Sterile","code_information":[{"code":"02333187","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3233.8,"discounted_cash":1616.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02333197","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6494.0,"discounted_cash":3247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Sinus 4.0Mm Curv Rad 40","code_information":[{"code":"02333531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1531.8,"discounted_cash":765.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pouch Specimen Endocatch 15Mm","code_information":[{"code":"02333560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.82,"discounted_cash":385.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02333567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02333752","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1261.7,"discounted_cash":630.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ventricular","code_information":[{"code":"02333865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1313.13,"discounted_cash":656.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scope Endo Neuro Channel","code_information":[{"code":"02333874","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13440.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Electrode","code_information":[{"code":"02333876","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":722.2,"discounted_cash":361.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Passer Subcutaneous 60Cm","code_information":[{"code":"02333877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1367.67,"discounted_cash":683.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Crescetic","code_information":[{"code":"02333878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1010.1,"discounted_cash":505.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guiderod Orthopedic Straight Intramedullary","code_information":[{"code":"02334036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1361.6,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Cannulated","code_information":[{"code":"02334037_43287","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1820.4,"discounted_cash":910.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Cannulated","code_information":[{"code":"02334037_43288","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1820.4,"discounted_cash":910.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Cannulated","code_information":[{"code":"02334037","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1820.4,"discounted_cash":910.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02334156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Ureter Access","code_information":[{"code":"02334167_129114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Ureter Access","code_information":[{"code":"02334167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneler Scanlan","code_information":[{"code":"02334170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":494.55,"discounted_cash":247.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain Blake 19F","code_information":[{"code":"02334260_35298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1167.25,"discounted_cash":583.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drain Blake 19F","code_information":[{"code":"02334260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1167.25,"discounted_cash":583.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02334271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable And Sleeve","code_information":[{"code":"02334529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2539.68,"discounted_cash":1269.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Kit Electrode","code_information":[{"code":"02334539","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Kit Electrode","code_information":[{"code":"02334539_110324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Peelaway 14Fr","code_information":[{"code":"02334573","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1182.07,"discounted_cash":591.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02334616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Heart","code_information":[{"code":"02334655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":27423.2,"discounted_cash":13711.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Occlusion","code_information":[{"code":"02334666","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.6,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Applier 5Mm Allport","code_information":[{"code":"02334758_3582801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Applier 5Mm Allport","code_information":[{"code":"02334758_75423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Clip Applier 5Mm Allport","code_information":[{"code":"02334758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1034.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02334762_103948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4294.88,"discounted_cash":2147.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02334789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Shaver Arthro","code_information":[{"code":"02334895_90100","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":824.11,"discounted_cash":412.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade Shaver Arthro","code_information":[{"code":"02334895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":834.35,"discounted_cash":417.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Putty 10Cc Chips","code_information":[{"code":"02334910_122597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7744.0,"discounted_cash":3872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Putty 10Cc Chips","code_information":[{"code":"02334910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7744.0,"discounted_cash":3872.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler Device","code_information":[{"code":"02334952","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Retriever Anchor","code_information":[{"code":"02334975_100050","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4798.42,"discounted_cash":2399.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Retriever Anchor","code_information":[{"code":"02334975","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3837.17,"discounted_cash":1918.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forcep Cutting","code_information":[{"code":"02334989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3193.87,"discounted_cash":1596.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Lead Stimulator Deep Brain With Accessory","code_information":[{"code":"02334996_110325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":19116.0,"discounted_cash":9558.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Lead Stimulator Deep Brain With Accessory","code_information":[{"code":"02334996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":19116.0,"discounted_cash":9558.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Set Obstructing","code_information":[{"code":"02335301","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":988.05,"discounted_cash":494.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02335349_44187","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02335349_44189","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02335349","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02335394_111304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02335394_39879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02335394_53079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02335394","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02335415","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":2703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Graft Aortic","code_information":[{"code":"02335440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29470.5,"discounted_cash":14735.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Intracor","code_information":[{"code":"02335484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":447.45,"discounted_cash":223.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Venous","code_information":[{"code":"02335751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3044.06,"discounted_cash":1522.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor Surgical","code_information":[{"code":"02335836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.95,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Linear Reload","code_information":[{"code":"02335890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.61,"discounted_cash":562.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Crimp","code_information":[{"code":"02335897","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3406.66,"discounted_cash":1703.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02335902_128897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2905.46,"discounted_cash":1452.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02335902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":1461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"02335916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc 5Fr Dual","code_information":[{"code":"02335940","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":901.32,"discounted_cash":450.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"\"Hc Graft Duragen Dural 4\"\"X5\"\"\"","code_information":[{"code":"02335964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8256.0,"discounted_cash":4128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02336036","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02336138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tray Perc Trach","code_information":[{"code":"02336159","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4088.16,"discounted_cash":2044.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02336346","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Spacer","code_information":[{"code":"02336423","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.4,"discounted_cash":447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cervical Ic Graft Chamber","code_information":[{"code":"02336587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9036.8,"discounted_cash":4518.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bag Specimen Retrieval 224Ml","code_information":[{"code":"02336616_40232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":647.63,"discounted_cash":323.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bag Specimen Retrieval 224Ml","code_information":[{"code":"02336616","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":647.63,"discounted_cash":323.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coupler Single","code_information":[{"code":"02336626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.5,"discounted_cash":1230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02336695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":9088.0,"discounted_cash":4544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02336699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":8424.45,"discounted_cash":4212.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Verres Suture","code_information":[{"code":"02336706_107127","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":498.48,"discounted_cash":249.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Verres Suture","code_information":[{"code":"02336706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":498.48,"discounted_cash":249.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stim Prass Slim Mono","code_information":[{"code":"02336757_127315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.84,"discounted_cash":466.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stim Prass Slim Mono","code_information":[{"code":"02336757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.84,"discounted_cash":466.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneling Rod","code_information":[{"code":"02336943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteochondral Autogr Trans Sys","code_information":[{"code":"02336986_90485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1831.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Osteochondral Autogr Trans Sys","code_information":[{"code":"02336986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3721.3,"discounted_cash":1860.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Hollow","code_information":[{"code":"02336989","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1587.3,"discounted_cash":793.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bolt Extraction","code_information":[{"code":"02336990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1062.27,"discounted_cash":531.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bolt Extraction","code_information":[{"code":"02336994","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1062.27,"discounted_cash":531.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02337020","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":4596.8,"discounted_cash":2298.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pleurex Drainage Bottle Kit","code_information":[{"code":"02337021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.36,"discounted_cash":208.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02337028","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4535.6,"discounted_cash":2267.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Wedge","code_information":[{"code":"02337034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6623.2,"discounted_cash":3311.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Filshie","code_information":[{"code":"02337051","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":967.18,"discounted_cash":483.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02337076_120935","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3654.94,"discounted_cash":1827.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02337076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1831.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02337077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4726.0,"discounted_cash":2363.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Curvtek Cartridge","code_information":[{"code":"02337109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4366.67,"discounted_cash":2183.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Infuse","code_information":[{"code":"02337159","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":18880.0,"discounted_cash":9440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Pusher","code_information":[{"code":"02337164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostat Flowable D-Stat","code_information":[{"code":"02337189","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1093.72,"discounted_cash":546.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Infuse","code_information":[{"code":"02337241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29680.0,"discounted_cash":14840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reaming Rod","code_information":[{"code":"02337264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1152.18,"discounted_cash":576.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Lead","code_information":[{"code":"02337313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tool Dissecting","code_information":[{"code":"02337426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1088.98,"discounted_cash":544.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Fiberloop","code_information":[{"code":"02337499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Novasure  Ablation System","code_information":[{"code":"02337510","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":7283.2,"discounted_cash":3641.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02337533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tool Cutting/Legend Metrix","code_information":[{"code":"02337570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1203.02,"discounted_cash":601.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinary Balloon","code_information":[{"code":"02337596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":20824.05,"discounted_cash":10412.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cement Bone Simplex","code_information":[{"code":"02337616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"discounted_cash":962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02337656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30240.0,"discounted_cash":15120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Transgastric-Jejunal","code_information":[{"code":"02337663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1725.53,"discounted_cash":862.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft","code_information":[{"code":"02337683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8064.0,"discounted_cash":4032.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tool Rod Carbide Cutting","code_information":[{"code":"02337777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":664.58,"discounted_cash":332.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Tricut","code_information":[{"code":"02337784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2320.64,"discounted_cash":1160.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vena Cava Filter","code_information":[{"code":"02337802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":8951.04,"discounted_cash":4475.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"02337823","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Endoscopic U/S Fna","code_information":[{"code":"02337833","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02337875","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":806.6,"discounted_cash":403.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Patella","code_information":[{"code":"02337883","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":468.88,"discounted_cash":234.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tool Dissecting Acorn","code_information":[{"code":"02337990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1292.78,"discounted_cash":646.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Viabahn Endoprothesis-Short","code_information":[{"code":"02337996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17700.0,"discounted_cash":8850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Viabahn Endoprothesis","code_information":[{"code":"02337999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":20974.5,"discounted_cash":10487.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Tapered Recipro","code_information":[{"code":"02338011","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":630.36,"discounted_cash":315.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Gastrostomy","code_information":[{"code":"02338085_118344","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":836.2,"discounted_cash":418.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Gastrostomy","code_information":[{"code":"02338085","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":836.2,"discounted_cash":418.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rod Guide","code_information":[{"code":"02338094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1738.26,"discounted_cash":869.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare Kit/Goose Neck","code_information":[{"code":"02338096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4114.0,"discounted_cash":2057.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Endo Pull Direct","code_information":[{"code":"02338117","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":869.5,"discounted_cash":434.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02338119","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Viatorr Coated","code_information":[{"code":"02338127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":31735.2,"discounted_cash":15867.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiberwire Ar-7204","code_information":[{"code":"02338141","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":459.23,"discounted_cash":229.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Norian","code_information":[{"code":"02338170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1022.31,"discounted_cash":511.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02338202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1035.33,"discounted_cash":517.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Inf Breeze","code_information":[{"code":"02338242","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":585.22,"discounted_cash":292.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Splint Nasal Denver","code_information":[{"code":"02338263_63361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.77,"discounted_cash":208.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Splint Nasal Denver","code_information":[{"code":"02338263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.77,"discounted_cash":208.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Putty 1Cc","code_information":[{"code":"02338281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Repair Univ Hemosplit Cath","code_information":[{"code":"02338299","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Accu-View","code_information":[{"code":"02338443","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":994.56,"discounted_cash":497.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cornerstone","code_information":[{"code":"02338481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Luminexx 40","code_information":[{"code":"02338520","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement W/Mixer","code_information":[{"code":"02338526","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1139.6,"discounted_cash":569.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon  Hurricane","code_information":[{"code":"02338530","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1824.84,"discounted_cash":912.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basket Trapazoid","code_information":[{"code":"02338546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2009.77,"discounted_cash":1004.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Saw","code_information":[{"code":"02338558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1531.8,"discounted_cash":765.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Saw","code_information":[{"code":"02338559_123097","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.2,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade Saw","code_information":[{"code":"02338559","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":914.2,"discounted_cash":457.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Cartilage Biopsy","code_information":[{"code":"02338563","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4188.8,"discounted_cash":2094.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Autotome Sphinctertom","code_information":[{"code":"02338565","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1587.82,"discounted_cash":793.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Power Catheter","code_information":[{"code":"02338573","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.88,"discounted_cash":368.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Ablation","code_information":[{"code":"02338587","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":6208.13,"discounted_cash":3104.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Cto","code_information":[{"code":"02338591","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc En Snare","code_information":[{"code":"02338603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2449.4,"discounted_cash":1224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kci Vac Sponge X-Large Kit","code_information":[{"code":"02338615","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":773.01,"discounted_cash":386.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Tamp Expander","code_information":[{"code":"02338627","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7223.04,"discounted_cash":3611.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer System 1-Step","code_information":[{"code":"02338628","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7097.6,"discounted_cash":3548.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Pump Synchromed C","code_information":[{"code":"02338644","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1772","type":"HCPCS"}],"standard_charges":[{"gross_charge":59826.4,"discounted_cash":29913.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02338646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":929.81,"discounted_cash":464.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embolization Microsphere","code_information":[{"code":"02338678","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":410.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Speak Passy-Muir","code_information":[{"code":"02338683_L8501_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.76,"discounted_cash":288.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Valve Speak Passy-Muir","code_information":[{"code":"02338683","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8501","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.76,"discounted_cash":288.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02338770_126685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6113.2,"discounted_cash":3056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02338770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6113.2,"discounted_cash":3056.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Mitral Cma","code_information":[{"code":"02338783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14720.0,"discounted_cash":7360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Acculink","code_information":[{"code":"02338805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":15929.6,"discounted_cash":7964.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Endurance Midline","code_information":[{"code":"02338876","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.43,"discounted_cash":335.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02338890","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1048.95,"discounted_cash":524.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Straight Marker","code_information":[{"code":"02338907","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1038.95,"discounted_cash":519.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Template Angled","code_information":[{"code":"02339045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":483.32,"discounted_cash":241.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Brace","code_information":[{"code":"02339093_80859","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1833","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.89,"discounted_cash":385.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Brace","code_information":[{"code":"02339093","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1833","type":"HCPCS"}],"standard_charges":[{"gross_charge":771.89,"discounted_cash":385.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Lasso","code_information":[{"code":"02339133","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Teflon","code_information":[{"code":"02339135","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2188.92,"discounted_cash":1094.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bio-Tenodesis Kit","code_information":[{"code":"02339141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":1091.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Array","code_information":[{"code":"02339158_111231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":12480.0,"discounted_cash":6240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrode Array","code_information":[{"code":"02339158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":12480.0,"discounted_cash":6240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Fiberwire","code_information":[{"code":"02339179_126213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Fiberwire","code_information":[{"code":"02339179_76716","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Fiberwire","code_information":[{"code":"02339179_91892","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Fiberwire","code_information":[{"code":"02339179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Xomed 3.5Mm","code_information":[{"code":"02339203","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3536.0,"discounted_cash":1768.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02339208","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":476.42,"discounted_cash":238.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02339223","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":4005.2,"discounted_cash":2002.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02339228","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5644.0,"discounted_cash":2822.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Roberts Uterine","code_information":[{"code":"02339253","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":449.41,"discounted_cash":224.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02339257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":5008.27,"discounted_cash":2504.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulm Zero Tip Bask","code_information":[{"code":"02339259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1907.13,"discounted_cash":953.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bone Cannul","code_information":[{"code":"02339264","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1625.78,"discounted_cash":812.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Gastrostomy Perc Peg Pull","code_information":[{"code":"02339323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":529.88,"discounted_cash":264.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Endo Gia Multifire","code_information":[{"code":"02339338_51139","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.22,"discounted_cash":481.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Endo Gia Multifire","code_information":[{"code":"02339338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.22,"discounted_cash":481.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cartridge Stapler Reload","code_information":[{"code":"02339339_51140","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":532.23,"discounted_cash":266.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cartridge Stapler Reload","code_information":[{"code":"02339339","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":532.23,"discounted_cash":266.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Internal","code_information":[{"code":"02339340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2133.27,"discounted_cash":1066.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bag Spec Endo Catch","code_information":[{"code":"02339362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.2,"discounted_cash":204.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reloadable Gia Sgl Use","code_information":[{"code":"02339364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.22,"discounted_cash":481.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mf Versatack Inst W/4.00Mm Sta","code_information":[{"code":"02339366_93413","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1086.32,"discounted_cash":543.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mf Versatack Inst W/4.00Mm Sta","code_information":[{"code":"02339366","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1086.32,"discounted_cash":543.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bravo Capsule W/Delivery Sys","code_information":[{"code":"02339374","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Battery System","code_information":[{"code":"02339376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary Express","code_information":[{"code":"02339385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4732.8,"discounted_cash":2366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02339387","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.8,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Assembly Strata Ii","code_information":[{"code":"02339390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30560.94,"discounted_cash":15280.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02339416_76711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.48,"discounted_cash":1462.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cath Slipcath 5Fr 100Cm","code_information":[{"code":"02339460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":449.41,"discounted_cash":224.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Scorpion","code_information":[{"code":"02339464_66704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Scorpion","code_information":[{"code":"02339464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finger Proximal","code_information":[{"code":"02339493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15222.02,"discounted_cash":7611.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finger Distal Imp","code_information":[{"code":"02339494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9746.56,"discounted_cash":4873.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Kit","code_information":[{"code":"02339501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1154.4,"discounted_cash":577.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Barrel Fluted","code_information":[{"code":"02339518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardioblate Bipolar System","code_information":[{"code":"02339536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":18260.5,"discounted_cash":9130.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealant Hemostatic","code_information":[{"code":"02339546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1143.1,"discounted_cash":571.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler","code_information":[{"code":"02339547_51170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":658.93,"discounted_cash":329.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler","code_information":[{"code":"02339547","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":658.93,"discounted_cash":329.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gelport Hand 100Mm Access Dev","code_information":[{"code":"02339550","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4862.0,"discounted_cash":2431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02339564_126873","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1945.61,"discounted_cash":972.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02339564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1918.08,"discounted_cash":959.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arndt Endobronchi Blocker Set","code_information":[{"code":"02339583","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1738.26,"discounted_cash":869.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Retractor","code_information":[{"code":"02339585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2982.2,"discounted_cash":1491.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finger Implant","code_information":[{"code":"02339587","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9746.56,"discounted_cash":4873.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare Fiberwire","code_information":[{"code":"02339603_3602312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Snare Fiberwire","code_information":[{"code":"02339603_52256","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Snare Fiberwire","code_information":[{"code":"02339603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Esophogeal Overtube Smooth","code_information":[{"code":"02339655","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Putty","code_information":[{"code":"02339697_120352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4440.4,"discounted_cash":2220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Putty","code_information":[{"code":"02339697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4440.4,"discounted_cash":2220.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wound Protector Medium","code_information":[{"code":"02339711","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Head Reamer","code_information":[{"code":"02339718","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2197.8,"discounted_cash":1098.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ventricular Bactiseal","code_information":[{"code":"02339719","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3907.55,"discounted_cash":1953.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Cont Cvd Cutter","code_information":[{"code":"02339724","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4624.0,"discounted_cash":2312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basket Escope","code_information":[{"code":"02339737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1747.36,"discounted_cash":873.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scissors Vertical","code_information":[{"code":"02339766","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1133.09,"discounted_cash":566.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Transbronchial Aspir","code_information":[{"code":"02339782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":643.61,"discounted_cash":321.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Xact Carotid","code_information":[{"code":"02339783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":13158.4,"discounted_cash":6579.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02339797","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4535.6,"discounted_cash":2267.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Adapter","code_information":[{"code":"02339798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":3998.4,"discounted_cash":1999.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealer Bi-Polar","code_information":[{"code":"02339850_68073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3580.84,"discounted_cash":1790.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sealer Bi-Polar","code_information":[{"code":"02339850","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3522.4,"discounted_cash":1761.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Drain Pleural","code_information":[{"code":"02339852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":486.7,"discounted_cash":243.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Breast Marker Clip","code_information":[{"code":"02339881_103250","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Breast Marker Clip","code_information":[{"code":"02339881_103251","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Breast Marker Clip","code_information":[{"code":"02339881_48158","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Breast Marker Clip","code_information":[{"code":"02339881","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dsg Vac Granufoam Silver Lg","code_information":[{"code":"02339896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":484.03,"discounted_cash":242.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02339900","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6664.0,"discounted_cash":3332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps End Grasping Mini","code_information":[{"code":"02339906","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1009.66,"discounted_cash":504.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Loop R-Angle Cutting","code_information":[{"code":"02339985_117179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrode Loop R-Angle Cutting","code_information":[{"code":"02339985","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02340003","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.4,"discounted_cash":521.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assistant Attachmnt Stablesoft","code_information":[{"code":"02340008","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3389.64,"discounted_cash":1694.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer","code_information":[{"code":"02340009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3691.37,"discounted_cash":1845.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Kit On-Q","code_information":[{"code":"02340024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":242.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paragon T2 W/Shaft","code_information":[{"code":"02340028","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1676.84,"discounted_cash":838.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trach Tube","code_information":[{"code":"02340036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":496.43,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Lasso","code_information":[{"code":"02340038_54196","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Lasso","code_information":[{"code":"02340038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Easy Spray","code_information":[{"code":"02340055","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.59,"discounted_cash":219.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Colpo-Pneumo Occluder","code_information":[{"code":"02340089","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":690.8,"discounted_cash":345.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embolization Protective System","code_information":[{"code":"02340098","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Excluder","code_information":[{"code":"02340099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28526.5,"discounted_cash":14263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02340104","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.27,"discounted_cash":286.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02340111_23081","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02340111","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Cement Spacer Tib","code_information":[{"code":"02340140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5752.8,"discounted_cash":2876.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Cement Spacer Fem","code_information":[{"code":"02340141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11417.6,"discounted_cash":5708.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw End Cap","code_information":[{"code":"02340143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1043.4,"discounted_cash":521.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Contour Pva","code_information":[{"code":"02340177","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":410.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Power Picc","code_information":[{"code":"02340272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1709.4,"discounted_cash":854.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Power Picc","code_information":[{"code":"02340273","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1857.4,"discounted_cash":928.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Fluency","code_information":[{"code":"02340291","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":14720.0,"discounted_cash":7360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02340294","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Fibertape","code_information":[{"code":"02340309_54098","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Fibertape","code_information":[{"code":"02340309","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Apc Flexible","code_information":[{"code":"02340325_3581188","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1987.64,"discounted_cash":993.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Apc Flexible","code_information":[{"code":"02340325_55393","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1987.64,"discounted_cash":993.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Apc Flexible","code_information":[{"code":"02340325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1987.64,"discounted_cash":993.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trach Shiley Xlt","code_information":[{"code":"02340327","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":460.56,"discounted_cash":230.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trach Shiley Xlt","code_information":[{"code":"02340328","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":496.43,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoscopic Applicator","code_information":[{"code":"02340346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":522.28,"discounted_cash":261.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple Loading Unit","code_information":[{"code":"02340402_79433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1623.71,"discounted_cash":811.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple Loading Unit","code_information":[{"code":"02340402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1623.71,"discounted_cash":811.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Bone Aspiration","code_information":[{"code":"02340412","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1055.24,"discounted_cash":527.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula","code_information":[{"code":"02340434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1731.6,"discounted_cash":865.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Safe Csg 9F 50Cm","code_information":[{"code":"02340444","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02340445","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":13408.0,"discounted_cash":6704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Dual Chamber","code_information":[{"code":"02340464","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":19658.8,"discounted_cash":9829.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Lead Acessory Kit","code_information":[{"code":"02340480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02340481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":964.29,"discounted_cash":482.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Clip Lapra-Ty Absorb","code_information":[{"code":"02340489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2233.39,"discounted_cash":1116.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02340512_119829","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2904.8,"discounted_cash":1452.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02340512_125463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2892.07,"discounted_cash":1446.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02340512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":1443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 10Ml Pre-Filled Syringe - 5 Pk","code_information":[{"code":"02340546","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":3315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hook Probe Serfas Energy","code_information":[{"code":"02340548","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Serfas Energy L Hook","code_information":[{"code":"02340549","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alexis Wound Retractor","code_information":[{"code":"02340552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02340568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1600.62,"discounted_cash":800.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Atlas Vessel Sealing","code_information":[{"code":"02340571","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2691.38,"discounted_cash":1345.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Atlas Vessel Sealing","code_information":[{"code":"02340571_60228","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2691.38,"discounted_cash":1345.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Vasoview 6 Accessory Pack","code_information":[{"code":"02340582","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":849.98,"discounted_cash":424.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nasopore Dressing 8Cm Firm","code_information":[{"code":"02340603","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1659.28,"discounted_cash":829.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Capture Grasping Forceps","code_information":[{"code":"02340638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1258.07,"discounted_cash":629.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Duplospray Mis Applicator","code_information":[{"code":"02340643","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":765.12,"discounted_cash":382.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cautery Eraser  Curved Tip","code_information":[{"code":"02340645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":546.69,"discounted_cash":273.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Generator  Neuro Non-Recharge","code_information":[{"code":"02340651_118594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":59254.0,"discounted_cash":29627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Generator  Neuro Non-Recharge","code_information":[{"code":"02340651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":59254.0,"discounted_cash":29627.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nim Electrode Kit","code_information":[{"code":"02340668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3901.5,"discounted_cash":1950.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02340673_60650","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.46,"discounted_cash":208.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02340673","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.46,"discounted_cash":208.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heart Valve","code_information":[{"code":"02340699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":39804.8,"discounted_cash":19902.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02340717","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2077.92,"discounted_cash":1038.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cartridge Stapler","code_information":[{"code":"02340720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":748.26,"discounted_cash":374.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02340732","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vascular Plug","code_information":[{"code":"02340740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4950.4,"discounted_cash":2475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02340762","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":2649.2,"discounted_cash":1324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coolant Tubing Set For Drill","code_information":[{"code":"02340780_104954","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":846.03,"discounted_cash":423.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Coolant Tubing Set For Drill","code_information":[{"code":"02340780","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":846.03,"discounted_cash":423.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Generator Restore Advance","code_information":[{"code":"02340800","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":82550.0,"discounted_cash":41275.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02340818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3794.4,"discounted_cash":1897.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Contour Pva","code_information":[{"code":"02340819","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":821.4,"discounted_cash":410.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02340821","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6757.76,"discounted_cash":3378.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wingspan Stent System","code_information":[{"code":"02340822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":32256.0,"discounted_cash":16128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Hemostasis Resolution","code_information":[{"code":"02340840","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02340928_76712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3540.16,"discounted_cash":1770.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tube Feeding Jejunal Balloon","code_information":[{"code":"02340943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1004.55,"discounted_cash":502.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02340949","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":7104.0,"discounted_cash":3552.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reservoir Holter Rickham Ventr","code_information":[{"code":"02340951","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3662.21,"discounted_cash":1831.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02340962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":3071.0,"discounted_cash":1535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent","code_information":[{"code":"02340967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":12768.0,"discounted_cash":6384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Pump","code_information":[{"code":"02340978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":55708.3,"discounted_cash":27854.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Checkflo","code_information":[{"code":"02340995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3433.6,"discounted_cash":1716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transtibial Acl Kit","code_information":[{"code":"02341009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":832.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transpolar Isolator Pen","code_information":[{"code":"02341040","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11840.0,"discounted_cash":5920.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02341064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":49252.0,"discounted_cash":24626.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Embolic Onyx Liquid","code_information":[{"code":"02341070","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17281.1,"discounted_cash":8640.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02341079","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode","code_information":[{"code":"02341124","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3041.18,"discounted_cash":1520.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02341162_128165","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02341162_128248","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02341162","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Zenith","code_information":[{"code":"02341183","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":58474.9,"discounted_cash":29237.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02341199_128584","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12288.0,"discounted_cash":6144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02341199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12288.0,"discounted_cash":6144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02341203_110323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2553.0,"discounted_cash":1276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02341203","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2553.0,"discounted_cash":1276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eye Silikon","code_information":[{"code":"02341210","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1814","type":"HCPCS"}],"standard_charges":[{"gross_charge":3403.63,"discounted_cash":1701.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Power","code_information":[{"code":"02341229_55890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.8,"discounted_cash":1672.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Port Power","code_information":[{"code":"02341229_C1788_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3344.8,"discounted_cash":1672.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Port Power","code_information":[{"code":"02341229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wire Lead Pacing Myocardial At","code_information":[{"code":"02341240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":405.58,"discounted_cash":202.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Nephroureteral","code_information":[{"code":"02341259","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":737.9,"discounted_cash":368.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Argon Straight Apc","code_information":[{"code":"02341289_106701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1796.72,"discounted_cash":898.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Argon Straight Apc","code_information":[{"code":"02341289_62335","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1796.72,"discounted_cash":898.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Argon Straight Apc","code_information":[{"code":"02341289","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1796.72,"discounted_cash":898.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02341291_129700","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.2,"discounted_cash":566.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02341291","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1132.2,"discounted_cash":566.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Saw Blade","code_information":[{"code":"02341298_126528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":786.03,"discounted_cash":393.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Saw Blade","code_information":[{"code":"02341298","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.3,"discounted_cash":385.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coseal 4Ml","code_information":[{"code":"02341335","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4332.82,"discounted_cash":2166.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneling Tool","code_information":[{"code":"02341341_125663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tunneling Tool","code_information":[{"code":"02341341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sutureless Connector Pump Kit","code_information":[{"code":"02341349","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealant Hemostatic Matrix","code_information":[{"code":"02341354_123330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2254.66,"discounted_cash":1127.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sealant Hemostatic Matrix","code_information":[{"code":"02341354","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2286.19,"discounted_cash":1143.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Instrument","code_information":[{"code":"02341362_127372","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3758.51,"discounted_cash":1879.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ligasure Instrument","code_information":[{"code":"02341362_95225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4199.0,"discounted_cash":2099.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ligasure Instrument","code_information":[{"code":"02341362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3611.68,"discounted_cash":1805.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02341367","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.8,"discounted_cash":1450.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Disposable Suture Pushlock","code_information":[{"code":"02341388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Power Port Open-Ended","code_information":[{"code":"02341412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02341461","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":417.46,"discounted_cash":208.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypothermia  Set Of 4 Pads Artic Sun","code_information":[{"code":"02341466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7171.04,"discounted_cash":3585.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypothermia Universal Pad Artic Sun","code_information":[{"code":"02341467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2708.57,"discounted_cash":1354.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Explant","code_information":[{"code":"02341476","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closesure System","code_information":[{"code":"02341479","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Enseal Laparoscopic","code_information":[{"code":"02341490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3411.12,"discounted_cash":1705.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Uni Soft Flex","code_information":[{"code":"02341528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.6,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02341564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteotome Flexible","code_information":[{"code":"02341570","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteotome Flexible","code_information":[{"code":"02341572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2686.2,"discounted_cash":1343.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Biventricular","code_information":[{"code":"02341585","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":33040.0,"discounted_cash":16520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Sleeve","code_information":[{"code":"02341589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Sleeve","code_information":[{"code":"02341589_73164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial Bushing Interface","code_information":[{"code":"02341592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2157.1,"discounted_cash":1078.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flo Trac Sensor","code_information":[{"code":"02341597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2516.0,"discounted_cash":1258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02341599","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"discounted_cash":962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Relieva Sinus Balloon Device","code_information":[{"code":"02341617","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":585.22,"discounted_cash":292.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc End Cap Star Drive","code_information":[{"code":"02341619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1503.75,"discounted_cash":751.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Plug Spine Polaris","code_information":[{"code":"02341626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Kit","code_information":[{"code":"02341640_126873","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":1128.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade Kit","code_information":[{"code":"02341640","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2257.0,"discounted_cash":1128.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath","code_information":[{"code":"02341660","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02341679","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":971.62,"discounted_cash":485.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02341696","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1305.58,"discounted_cash":652.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02341699","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34132.0,"discounted_cash":17066.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureretal","code_information":[{"code":"02341709","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.11,"discounted_cash":267.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Autosuture Roticulator","code_information":[{"code":"02341736","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Atec Biopsy Needle","code_information":[{"code":"02341747","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2516.0,"discounted_cash":1258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Atec Introducer","code_information":[{"code":"02341748","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Atec Biopsy Site Identifier","code_information":[{"code":"02341751","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.2,"discounted_cash":282.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02341757","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":16048.0,"discounted_cash":8024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer","code_information":[{"code":"02341773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":645.9,"discounted_cash":322.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode High Frequency","code_information":[{"code":"02341785","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":731.33,"discounted_cash":365.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knife","code_information":[{"code":"02341786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1545.48,"discounted_cash":772.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cutter Endoscopic","code_information":[{"code":"02341799_35544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1531.8,"discounted_cash":765.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cutter Endoscopic","code_information":[{"code":"02341799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1531.8,"discounted_cash":765.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh","code_information":[{"code":"02341823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":19753.2,"discounted_cash":9876.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Roticulator Endo","code_information":[{"code":"02341831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1142.03,"discounted_cash":571.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chest Tube","code_information":[{"code":"02341847","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1630.22,"discounted_cash":815.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Aaa","code_information":[{"code":"02341848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":34053.6,"discounted_cash":17026.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Fixation Washerloc","code_information":[{"code":"02341851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3219.0,"discounted_cash":1609.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plug Alpha I True-Lock","code_information":[{"code":"02341852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1080.4,"discounted_cash":540.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Bio-Tenodesis Disp","code_information":[{"code":"02341870_3583240","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Bio-Tenodesis Disp","code_information":[{"code":"02341870_65164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Bio-Tenodesis Disp","code_information":[{"code":"02341870","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accudrain Bag","code_information":[{"code":"02341891","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":429.71,"discounted_cash":214.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Evac Plasma Wand","code_information":[{"code":"02341893_126797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2245.53,"discounted_cash":1122.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Evac Plasma Wand","code_information":[{"code":"02341893","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2245.53,"discounted_cash":1122.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer","code_information":[{"code":"02341900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02341918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":744.66,"discounted_cash":372.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Biopsy Device","code_information":[{"code":"02341922","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":846.56,"discounted_cash":423.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02341928","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2123.8,"discounted_cash":1061.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Pancreatic","code_information":[{"code":"02341934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Orthocord","code_information":[{"code":"02341968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4426.8,"discounted_cash":2213.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Orthocord","code_information":[{"code":"02341968_65697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4426.8,"discounted_cash":2213.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Trocar","code_information":[{"code":"02341969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.38,"discounted_cash":197.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transfer Set Minicap","code_information":[{"code":"02341973","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":676.66,"discounted_cash":338.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Detachable Loop Ligating Devic","code_information":[{"code":"02341983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Fusion","code_information":[{"code":"02341987","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02341993","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":9984.0,"discounted_cash":4992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Aaa Zenith Zip","code_information":[{"code":"02342004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12070.4,"discounted_cash":6035.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Duraseal","code_information":[{"code":"02342011","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6721.05,"discounted_cash":3360.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Kit With Dilator","code_information":[{"code":"02342029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1573.83,"discounted_cash":786.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Pump W/Iz","code_information":[{"code":"02342042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":41550.6,"discounted_cash":20775.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Splint Post Foot","code_information":[{"code":"02342103","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1930","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Collagen","code_information":[{"code":"02342109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14689.28,"discounted_cash":7344.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rotablator Artherectomy","code_information":[{"code":"02342122","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22390.5,"discounted_cash":11195.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sphincterotome Omni-Tome","code_information":[{"code":"02342131","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2168.2,"discounted_cash":1084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Infuse","code_information":[{"code":"02342148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12192.0,"discounted_cash":6096.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02342177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.03,"discounted_cash":412.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Curved Needle","code_information":[{"code":"02342182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2710.62,"discounted_cash":1355.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02342205","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8353.28,"discounted_cash":4176.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ria Reamer Head","code_information":[{"code":"02342210","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2782.03,"discounted_cash":1391.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Scorpion","code_information":[{"code":"02342224_3601659","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Scorpion","code_information":[{"code":"02342224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Scorpion","code_information":[{"code":"02342224_69555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Embolectomy","code_information":[{"code":"02342246","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":758.43,"discounted_cash":379.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Vac Granufoam Lg","code_information":[{"code":"02342258","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":577.34,"discounted_cash":288.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Illumination System Sinus","code_information":[{"code":"02342260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3174.6,"discounted_cash":1587.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Tunneler","code_information":[{"code":"02342261","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":406.05,"discounted_cash":203.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Micro","code_information":[{"code":"02342265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5426.4,"discounted_cash":2713.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Micro","code_information":[{"code":"02342266","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6018.0,"discounted_cash":3009.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Allograft","code_information":[{"code":"02342286","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ultrasound","code_information":[{"code":"02342291","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":16679.3,"discounted_cash":8339.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Epidural","code_information":[{"code":"02342295","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02342302","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula","code_information":[{"code":"02342303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":529.88,"discounted_cash":264.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02342308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02342310","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.8,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02342311","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.8,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Laser","code_information":[{"code":"02342323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Spine Stimulator Accessory","code_information":[{"code":"02342330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Epidural","code_information":[{"code":"02342334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":600.29,"discounted_cash":300.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"02342346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5922.8,"discounted_cash":2961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02342358_111232","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":8928.0,"discounted_cash":4464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02342358","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":8928.0,"discounted_cash":4464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02342362_124789","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02342362_125853","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02342362_127925","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02342362","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Tubing Disposable","code_information":[{"code":"02342366","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":732.64,"discounted_cash":366.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic Homograft","code_information":[{"code":"02342369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":79500.0,"discounted_cash":39750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cap Locking","code_information":[{"code":"02342374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finger Implant Silicone","code_information":[{"code":"02342383","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8908.48,"discounted_cash":4454.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Putty","code_information":[{"code":"02342387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1406.0,"discounted_cash":703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc End Cap","code_information":[{"code":"02342389","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1894.55,"discounted_cash":947.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tigertape","code_information":[{"code":"02342406_122002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tigertape","code_information":[{"code":"02342406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Strut","code_information":[{"code":"02342407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealer Bi-Polar","code_information":[{"code":"02342415","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3760.4,"discounted_cash":1880.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Pupil Expander","code_information":[{"code":"02342421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1079.17,"discounted_cash":539.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spine System Plug Devotation","code_information":[{"code":"02342422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ventricular Bolt Press Monitor","code_information":[{"code":"02342423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5581.71,"discounted_cash":2790.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02342424","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.24,"discounted_cash":1027.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microdebrider Topaz","code_information":[{"code":"02342444","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2667.7,"discounted_cash":1333.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Power Port Dual Lumen","code_information":[{"code":"02342466","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":1461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem Centralizer","code_information":[{"code":"02342471","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":795.5,"discounted_cash":397.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Annuloplasty Mitral","code_information":[{"code":"02342472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14720.0,"discounted_cash":7360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Saw Blade","code_information":[{"code":"02342482_117029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.35,"discounted_cash":200.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Saw Blade","code_information":[{"code":"02342482_128588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.35,"discounted_cash":200.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Saw Blade","code_information":[{"code":"02342482_3583028","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.35,"discounted_cash":200.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Saw Blade","code_information":[{"code":"02342482_83702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.35,"discounted_cash":200.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Saw Blade","code_information":[{"code":"02342482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.35,"discounted_cash":200.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent E-Luminexx","code_information":[{"code":"02342492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6120.0,"discounted_cash":3060.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Bonopty Penetration Set","code_information":[{"code":"02342501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":499.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Bonopty Biopsy Set","code_information":[{"code":"02342502","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Bonopty Extension Drill","code_information":[{"code":"02342503","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bicep Distal Repair Implant","code_information":[{"code":"02342507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5780.0,"discounted_cash":2890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02342509","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4896.0,"discounted_cash":2448.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02342515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02342519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex","code_information":[{"code":"02342538","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":7521.15,"discounted_cash":3760.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex","code_information":[{"code":"02342542","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":19355.42,"discounted_cash":9677.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex","code_information":[{"code":"02342545","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":46816.0,"discounted_cash":23408.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Microplex Cosmos","code_information":[{"code":"02342562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13600.0,"discounted_cash":6800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Delivery System Scoutpro","code_information":[{"code":"02342596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5236.0,"discounted_cash":2618.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent W Delivery System","code_information":[{"code":"02342597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":11063.1,"discounted_cash":5531.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Wallflex Esophageal","code_information":[{"code":"02342598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":12768.0,"discounted_cash":6384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Wallflex Enteral","code_information":[{"code":"02342599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":15929.6,"discounted_cash":7964.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02342606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1871.59,"discounted_cash":935.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Tibialis","code_information":[{"code":"02342623_127598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7890.18,"discounted_cash":3945.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tendon Tibialis","code_information":[{"code":"02342623_80448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8047.57,"discounted_cash":4023.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tendon Tibialis","code_information":[{"code":"02342623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7822.72,"discounted_cash":3911.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02342633","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":19617.5,"discounted_cash":9808.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp","code_information":[{"code":"02342634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2286.6,"discounted_cash":1143.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp","code_information":[{"code":"02342635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3233.8,"discounted_cash":1616.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor Alexis Wound","code_information":[{"code":"02342638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":843.6,"discounted_cash":421.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02342661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02342663_86550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.8,"discounted_cash":543.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02342680","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":77250.0,"discounted_cash":38625.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Retrograde","code_information":[{"code":"02342685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":774.56,"discounted_cash":387.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Infusion","code_information":[{"code":"02342687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6494.0,"discounted_cash":3247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02342690_35441","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1502.2,"discounted_cash":751.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Blade","code_information":[{"code":"02342690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1502.2,"discounted_cash":751.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp Craniofix","code_information":[{"code":"02342691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.81,"discounted_cash":593.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Block Bone Void Filler","code_information":[{"code":"02342696_123838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3396.6,"discounted_cash":1698.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Block Bone Void Filler","code_information":[{"code":"02342696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3396.6,"discounted_cash":1698.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp Craniofix","code_information":[{"code":"02342697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":835.02,"discounted_cash":417.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02342717","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":95318.25,"discounted_cash":47659.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02342718_95564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02342720","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":16691.1,"discounted_cash":8345.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laparoscopic Suturing Device","code_information":[{"code":"02342726","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":833.46,"discounted_cash":416.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vacuum System","code_information":[{"code":"02342728","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8704.58,"discounted_cash":4352.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02342730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Single Use","code_information":[{"code":"02342739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2546.86,"discounted_cash":1273.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Loading Unit Single Use","code_information":[{"code":"02342740","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":532.23,"discounted_cash":266.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Single Use Reloadable","code_information":[{"code":"02342743_69771","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.11,"discounted_cash":318.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Single Use Reloadable","code_information":[{"code":"02342743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":637.11,"discounted_cash":318.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgiclip Titanium","code_information":[{"code":"02342752","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":449.26,"discounted_cash":224.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Clip Pistol Grip","code_information":[{"code":"02342753_69784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":642.01,"discounted_cash":321.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Clip Pistol Grip","code_information":[{"code":"02342753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":640.64,"discounted_cash":320.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Grasper","code_information":[{"code":"02342758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":980.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Ball Set","code_information":[{"code":"02342762","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement","code_information":[{"code":"02342771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.8,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Dilator","code_information":[{"code":"02342773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.38,"discounted_cash":197.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heartstring Seal System","code_information":[{"code":"02342776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3754.08,"discounted_cash":1877.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02342783_20691","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.9,"discounted_cash":882.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02342783","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1764.9,"discounted_cash":882.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Deflectable","code_information":[{"code":"02342796","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3712.8,"discounted_cash":1856.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple Bone Acl Fixation","code_information":[{"code":"02342804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.2,"discounted_cash":1269.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Waffle Foothold","code_information":[{"code":"02342825","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4396","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Diagnostic","code_information":[{"code":"02342828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":494.55,"discounted_cash":247.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Catheter Intrathecal","code_information":[{"code":"02342844","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Esophageal","code_information":[{"code":"02342846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":16000.0,"discounted_cash":8000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary Wallflex","code_information":[{"code":"02342847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15948.54,"discounted_cash":7974.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Mitral","code_information":[{"code":"02342871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":32648.0,"discounted_cash":16324.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coupler Single","code_information":[{"code":"02342884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.5,"discounted_cash":1230.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Tamponade","code_information":[{"code":"02342905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2544.12,"discounted_cash":1272.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02342917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":41412.0,"discounted_cash":20706.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02342918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29792.0,"discounted_cash":14896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary","code_information":[{"code":"02342920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Feeding Transgastric","code_information":[{"code":"02342935","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2516.0,"discounted_cash":1258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dilator Vascular","code_information":[{"code":"02342943","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1346.8,"discounted_cash":673.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dilator Vascular","code_information":[{"code":"02342944","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1820.4,"discounted_cash":910.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"02342956","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3542.8,"discounted_cash":1771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reloadable Sing Use","code_information":[{"code":"02342962","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1507.9,"discounted_cash":753.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Brush Fistula","code_information":[{"code":"02342977","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":604.45,"discounted_cash":302.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Pump 4-5 Day","code_information":[{"code":"02342996","type":"CDM"},{"code":"272","type":"RC"},{"code":"C9804","type":"HCPCS"}],"standard_charges":[{"gross_charge":1529.59,"discounted_cash":764.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Kit","code_information":[{"code":"02342997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":951.17,"discounted_cash":475.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Locking Device","code_information":[{"code":"02343002","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":11328.0,"discounted_cash":5664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Locking Device 1 2 3","code_information":[{"code":"02343003","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":4012.0,"discounted_cash":2006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cutter Lld Lead","code_information":[{"code":"02343004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":753.6,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Lld Accessory","code_information":[{"code":"02343005","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc External Fixation Pin","code_information":[{"code":"02343009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":950.16,"discounted_cash":475.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure - Blunt Tip","code_information":[{"code":"02343010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3339.25,"discounted_cash":1669.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilator","code_information":[{"code":"02343017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":893.92,"discounted_cash":446.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Saber W/Integrated Cable","code_information":[{"code":"02343032","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1887.0,"discounted_cash":943.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02343034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2103.08,"discounted_cash":1051.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Prosthesis Reservoir","code_information":[{"code":"02343037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":19731.08,"discounted_cash":9865.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02343042_93628","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.04,"discounted_cash":813.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02343042_93629","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.04,"discounted_cash":813.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02343042","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1627.04,"discounted_cash":813.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02343064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2867.72,"discounted_cash":1433.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02343065","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4250.0,"discounted_cash":2125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02343066","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02343070","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elevator Surgical Spinal Cord","code_information":[{"code":"02343079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Triple Lumen Catheter Kit Max","code_information":[{"code":"02343088","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.6,"discounted_cash":458.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cement Kit","code_information":[{"code":"02343091","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6418.86,"discounted_cash":3209.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Introducer","code_information":[{"code":"02343092","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw Conical Extraction","code_information":[{"code":"02343118","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1135.53,"discounted_cash":567.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Tube For Hollow Reamer","code_information":[{"code":"02343120","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1918.08,"discounted_cash":959.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Tube For Hollow Reamer","code_information":[{"code":"02343120_71253","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1918.08,"discounted_cash":959.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02343121","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Central Venous Catheter Dual Lumen","code_information":[{"code":"02343122","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.12,"discounted_cash":439.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Saw Blade","code_information":[{"code":"02343144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":521.55,"discounted_cash":260.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Tri Vascular","code_information":[{"code":"02343159","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1241.42,"discounted_cash":620.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Endoscopic Ultra","code_information":[{"code":"02343160_71475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.89,"discounted_cash":387.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Endoscopic Ultra","code_information":[{"code":"02343160","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.89,"discounted_cash":387.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Washer","code_information":[{"code":"02343163_130608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.57,"discounted_cash":356.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Washer","code_information":[{"code":"02343163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":713.57,"discounted_cash":356.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Matrix","code_information":[{"code":"02343170","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"gross_charge":10752.0,"discounted_cash":5376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02343175","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3478.0,"discounted_cash":1739.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular Lifestent Xl","code_information":[{"code":"02343182","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":13632.0,"discounted_cash":6816.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Reinforcement Stratt","code_information":[{"code":"02343184","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"gross_charge":14393.6,"discounted_cash":7196.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Resectoscope","code_information":[{"code":"02343185","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":997.37,"discounted_cash":498.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg","code_information":[{"code":"02343206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.2,"discounted_cash":282.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Positioning Device Sup Disp","code_information":[{"code":"02343208_101115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":408.2,"discounted_cash":204.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Positioning Device Sup Disp","code_information":[{"code":"02343208","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.6,"discounted_cash":384.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Eflex Chisel Probe","code_information":[{"code":"02343210","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3672.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer","code_information":[{"code":"02343225_87787","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":474.93,"discounted_cash":237.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Introducer","code_information":[{"code":"02343225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":474.93,"discounted_cash":237.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adapter Hip Head","code_information":[{"code":"02343228","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adapter Hip Head","code_information":[{"code":"02343228_71911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":723.33,"discounted_cash":361.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02343229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":1969.88,"discounted_cash":984.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reload","code_information":[{"code":"02343236_71983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1695.78,"discounted_cash":847.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Reload","code_information":[{"code":"02343236","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1695.78,"discounted_cash":847.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Interventional Guide","code_information":[{"code":"02343249","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Peg Od14","code_information":[{"code":"02343253","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Kit Equistream","code_information":[{"code":"02343263","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.94,"discounted_cash":1239.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Interv Vari-Lase","code_information":[{"code":"02343274","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Low Profile","code_information":[{"code":"02343279","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Angiographic","code_information":[{"code":"02343281","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.85,"discounted_cash":218.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Angiographic Aurous","code_information":[{"code":"02343283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":937.03,"discounted_cash":468.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Kit Unit Dressing","code_information":[{"code":"02343288","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3296.7,"discounted_cash":1648.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Dressing 13 Cm And 20 Cm","code_information":[{"code":"02343289","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1964.7,"discounted_cash":982.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Dilator","code_information":[{"code":"02343293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2248.27,"discounted_cash":1124.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp External Fixation","code_information":[{"code":"02343315_104581","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3478.0,"discounted_cash":1739.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Clamp External Fixation","code_information":[{"code":"02343315_104593","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3478.0,"discounted_cash":1739.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Clamp External Fixation","code_information":[{"code":"02343315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3478.0,"discounted_cash":1739.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02343325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.4,"discounted_cash":632.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Lead","code_information":[{"code":"02343330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer 24Cm","code_information":[{"code":"02343331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":569.67,"discounted_cash":284.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chip Cancellous","code_information":[{"code":"02343348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chip Cancellous","code_information":[{"code":"02343349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cube Cancellous","code_information":[{"code":"02343350_88585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cube Cancellous","code_information":[{"code":"02343350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cube Cancellous","code_information":[{"code":"02343351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cortical Strut","code_information":[{"code":"02343354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2997.0,"discounted_cash":1498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue","code_information":[{"code":"02343390","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19824.0,"discounted_cash":9912.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C Collar 6 Aspen No Pads","code_information":[{"code":"02343398","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0174","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.1,"discounted_cash":1023.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lso 18 Miami Ossur Chairback","code_information":[{"code":"02343410","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0637","type":"HCPCS"}],"standard_charges":[{"gross_charge":8232.26,"discounted_cash":4116.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Purple Reloac","code_information":[{"code":"02343444_73107","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1288.86,"discounted_cash":644.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Purple Reloac","code_information":[{"code":"02343444","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1288.86,"discounted_cash":644.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Hdc 10Cm X 10Cm","code_information":[{"code":"02343463","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15288.0,"discounted_cash":7644.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg Fixation Femoral Knee","code_information":[{"code":"02343475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1683.5,"discounted_cash":841.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Liver Resection Reload","code_information":[{"code":"02343484","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1501.09,"discounted_cash":750.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Equiestream","code_information":[{"code":"02343485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2478.94,"discounted_cash":1239.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Power Trialysis","code_information":[{"code":"02343487","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.05,"discounted_cash":641.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02343490","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":1091.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cyberwand Lithotripter Ultra","code_information":[{"code":"02343492","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5303.46,"discounted_cash":2651.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.31,"discounted_cash":197.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343548_91071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343548_91073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343548_93491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343549_75271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.28,"discounted_cash":238.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343549_75629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.28,"discounted_cash":238.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.28,"discounted_cash":238.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343550_75271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.09,"discounted_cash":262.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343550_75629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.09,"discounted_cash":262.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.09,"discounted_cash":262.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343551_109999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343551_110001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343551_41467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343551_42508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343551_45251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343552_50442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343552_50443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343553_118866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343554_129532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_129533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343554_129534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_129535","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_130004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_71708","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_74255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_75715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_76732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343554_76733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555_125677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555_50167","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555_50442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555_50443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555_70518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343556_117458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_117854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_121923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_121924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_125058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343556_127990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343556_128125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343556_128630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_129550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_130892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_130893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_131368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_43354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_43355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343556_75265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_125674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_125675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_126419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_75265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_75325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557_92993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343558_100169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_109855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_109897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_110647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343558_110918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343558_111551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_111879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_113188","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_114267","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_117958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_118372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_126015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_128121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_128538","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_128539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_128540","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_128541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129245","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129251","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129252","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_129830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_130037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_83142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_92995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_93172","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343558_93177","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_115821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_128145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_128533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_128534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_128608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_128609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_129054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_129219","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343559_129387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_129641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_130828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_130829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_130923","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343559_91202","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_114369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_120271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_128612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_128613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_130426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_17510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_78608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560_79168","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_100139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_100140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_101058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_101060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_103319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_109895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_109896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_110847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_111808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_112196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_112309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_112960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_113571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_114266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_123107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_123612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_123613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_127575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_127959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_128126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_128129","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_128130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_128131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129406","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129541","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_129549","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3585055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3585871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3585873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3585894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3586539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_3586769","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_78594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_78759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_79994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_80003","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_99486","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_99494","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343561_99833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343561_99834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343562_128886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343562_130047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343562_62980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343563_100141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343563_130122","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343563_130397","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343563_131006","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343564_106653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343564_127861","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343564_127862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343564_128254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343565_103379","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_103605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_104552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_114712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_117548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_125044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_125171","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127852","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_127853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129412","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129414","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129419","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129420","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129944","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_129945","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343565_130289","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2277.2,"discounted_cash":1138.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2504.97,"discounted_cash":1252.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343568_129912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_129913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343568_130609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_130610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_130629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_69650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_69651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343568_78426","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2755.54,"discounted_cash":1377.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343569_128585","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.19,"discounted_cash":1515.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343569_89084","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.19,"discounted_cash":1515.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.19,"discounted_cash":1515.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.37,"discounted_cash":1667.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343571_109857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343571_115570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343571_128754","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343571_83147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3707.56,"discounted_cash":1853.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343573_117864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343573_120863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343573_130723","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343573_131014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343574_116190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.3,"discounted_cash":2243.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.3,"discounted_cash":2243.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4935.03,"discounted_cash":2467.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343576","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5428.58,"discounted_cash":2714.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343577_129483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577_129654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577_130121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577_130396","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577_131012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577_131192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5971.56,"discounted_cash":2985.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.64,"discounted_cash":3400.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7480.77,"discounted_cash":3740.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343581_129314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8228.93,"discounted_cash":4114.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02343581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8228.93,"discounted_cash":4114.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343582","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9051.9,"discounted_cash":4525.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02343583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9957.12,"discounted_cash":4978.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":481.86,"discounted_cash":240.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":583.14,"discounted_cash":291.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343597","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.06,"discounted_cash":294.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.91,"discounted_cash":323.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343599","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":711.65,"discounted_cash":355.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.87,"discounted_cash":391.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.25,"discounted_cash":430.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1042.2,"discounted_cash":521.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343604","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1146.48,"discounted_cash":573.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1261.21,"discounted_cash":630.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1526.14,"discounted_cash":763.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1678.82,"discounted_cash":839.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1846.79,"discounted_cash":923.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.48,"discounted_cash":1015.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2234.71,"discounted_cash":1117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2458.23,"discounted_cash":1229.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2704.13,"discounted_cash":1352.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3034.09,"discounted_cash":1517.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3337.59,"discounted_cash":1668.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3671.39,"discounted_cash":1835.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343618","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4038.59,"discounted_cash":2019.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4442.51,"discounted_cash":2221.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4886.77,"discounted_cash":2443.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343631","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12029.69,"discounted_cash":6014.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343633","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14556.04,"discounted_cash":7278.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02343634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16011.69,"discounted_cash":8005.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":408.44,"discounted_cash":204.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343651_123862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.39,"discounted_cash":247.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343651_128611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.39,"discounted_cash":247.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.39,"discounted_cash":247.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343652_128564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.85,"discounted_cash":271.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.85,"discounted_cash":271.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":598.33,"discounted_cash":299.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343654_130504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.22,"discounted_cash":329.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":658.22,"discounted_cash":329.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.03,"discounted_cash":375.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":908.87,"discounted_cash":454.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.81,"discounted_cash":499.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.86,"discounted_cash":549.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343661_128563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.9,"discounted_cash":604.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1209.9,"discounted_cash":604.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343662_128580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1330.96,"discounted_cash":665.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1330.96,"discounted_cash":665.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343663_110625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.16,"discounted_cash":732.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1464.16,"discounted_cash":732.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343664","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.68,"discounted_cash":805.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.78,"discounted_cash":885.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1949.09,"discounted_cash":974.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.0,"discounted_cash":1072.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2358.53,"discounted_cash":1179.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2594.44,"discounted_cash":1297.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2853.96,"discounted_cash":1426.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3139.45,"discounted_cash":1569.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3453.43,"discounted_cash":1726.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3490.85,"discounted_cash":1745.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3840.03,"discounted_cash":1920.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343675_129547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.09,"discounted_cash":2112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343675_129607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.09,"discounted_cash":2112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343675_129833","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.09,"discounted_cash":2112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343675_130290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.09,"discounted_cash":2112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4224.09,"discounted_cash":2112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343676_130046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.51,"discounted_cash":2323.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4646.51,"discounted_cash":2323.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343677_128771","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_129545","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_129546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343677_130204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_130440","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_90283","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_91078","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_93490","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_93502","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343677_94083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5111.29,"discounted_cash":2555.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343678_130033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5622.44,"discounted_cash":2811.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343678_131488","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5622.44,"discounted_cash":2811.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343678","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5622.44,"discounted_cash":2811.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343679_106614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6184.8,"discounted_cash":3092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343679_128629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6184.8,"discounted_cash":3092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343679_82007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6184.8,"discounted_cash":3092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343679","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6184.8,"discounted_cash":3092.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343680_129244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6403.14,"discounted_cash":3201.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343680_129250","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6403.14,"discounted_cash":3201.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6403.14,"discounted_cash":3201.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343681_126350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7043.52,"discounted_cash":3521.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343681_3586832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7043.52,"discounted_cash":3521.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343681_77652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7043.52,"discounted_cash":3521.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7043.52,"discounted_cash":3521.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343682_128537","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.9,"discounted_cash":3873.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343682_128619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.9,"discounted_cash":3873.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343682_94804","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.9,"discounted_cash":3873.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7747.9,"discounted_cash":3873.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343683_109893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_117431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_118373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_120398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_123105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_123782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_125014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_130002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_130007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_130318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343683_3585893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8522.75,"discounted_cash":4261.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343684_127949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9375.1,"discounted_cash":4687.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9375.1,"discounted_cash":4687.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343685","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10312.7,"discounted_cash":5156.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343686_103315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11344.0,"discounted_cash":5672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11344.0,"discounted_cash":5672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343686_120736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11344.0,"discounted_cash":5672.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343687","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12478.46,"discounted_cash":6239.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343688_117455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13726.4,"discounted_cash":6863.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13726.4,"discounted_cash":6863.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343689_117916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15099.07,"discounted_cash":7549.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15099.07,"discounted_cash":7549.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343690_129405","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15311.5,"discounted_cash":7655.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343690","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15311.5,"discounted_cash":7655.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16842.67,"discounted_cash":8421.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343692_129551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18527.0,"discounted_cash":9263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343692","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18527.0,"discounted_cash":9263.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343693","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20379.78,"discounted_cash":10189.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343694_117840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":22417.82,"discounted_cash":11208.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":22417.82,"discounted_cash":11208.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24659.64,"discounted_cash":12329.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343696_120862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":27125.66,"discounted_cash":13562.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Plate","code_information":[{"code":"02343696","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":27125.66,"discounted_cash":13562.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28321.1,"discounted_cash":14160.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":31153.25,"discounted_cash":15576.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate","code_information":[{"code":"02343700","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":37695.56,"discounted_cash":18847.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wrist Implant","code_information":[{"code":"02343768","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15383.42,"discounted_cash":7691.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgical Device Sterile Disp","code_information":[{"code":"02343774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1077.44,"discounted_cash":538.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sacrocolpopexy Tip","code_information":[{"code":"02343795","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.15,"discounted_cash":388.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Flexible","code_information":[{"code":"02343809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":952.38,"discounted_cash":476.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4819.76,"discounted_cash":2409.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343814","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5374.59,"discounted_cash":2687.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343815","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5912.08,"discounted_cash":2956.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816_3601858","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816_74072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816_74291","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816_74478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816_75312","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6503.34,"discounted_cash":3251.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7153.73,"discounted_cash":3576.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_130057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_68528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_70158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_76566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_77094","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818_78628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343818","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7869.16,"discounted_cash":3934.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343819","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8656.13,"discounted_cash":4328.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9521.78,"discounted_cash":4760.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343821","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10474.02,"discounted_cash":5237.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11521.49,"discounted_cash":5760.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343823","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11864.69,"discounted_cash":5932.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343824","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13051.24,"discounted_cash":6525.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14356.36,"discounted_cash":7178.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15792.08,"discounted_cash":7896.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343827","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17371.33,"discounted_cash":8685.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343828","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19108.5,"discounted_cash":9554.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343829","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21019.37,"discounted_cash":10509.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21019.44,"discounted_cash":10509.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343831","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":23121.4,"discounted_cash":11560.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343832","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":25433.6,"discounted_cash":12716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":30774.72,"discounted_cash":15387.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2754.0,"discounted_cash":1377.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343839","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3332.44,"discounted_cash":1666.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343840","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3665.73,"discounted_cash":1832.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343841","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4032.37,"discounted_cash":2016.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343842_109305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4435.67,"discounted_cash":2217.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4435.67,"discounted_cash":2217.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4879.27,"discounted_cash":2439.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343844_9099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.28,"discounted_cash":2473.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343844_9104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.28,"discounted_cash":2473.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343844_95780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.28,"discounted_cash":2473.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343844","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4946.28,"discounted_cash":2473.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343845_85528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.96,"discounted_cash":2720.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343845_85552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.96,"discounted_cash":2720.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.96,"discounted_cash":2720.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5985.12,"discounted_cash":2992.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6583.67,"discounted_cash":3291.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343848","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7242.09,"discounted_cash":3621.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343849","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7966.36,"discounted_cash":3983.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8763.01,"discounted_cash":4381.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9639.37,"discounted_cash":4819.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343852","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10603.34,"discounted_cash":5301.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11663.71,"discounted_cash":5831.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343854_100669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12011.21,"discounted_cash":6005.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343854_102066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12011.21,"discounted_cash":6005.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343854","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12011.21,"discounted_cash":6005.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13212.36,"discounted_cash":6606.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02343856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14533.64,"discounted_cash":7266.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2184.05,"discounted_cash":1092.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2402.51,"discounted_cash":1201.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2642.81,"discounted_cash":1321.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343865","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2695.71,"discounted_cash":1347.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343866","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2965.34,"discounted_cash":1482.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343867_129024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3261.91,"discounted_cash":1630.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343867","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3261.91,"discounted_cash":1630.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343868","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3588.16,"discounted_cash":1794.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343869","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3947.04,"discounted_cash":1973.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4341.78,"discounted_cash":2170.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343871_109666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4776.0,"discounted_cash":2388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343871","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4776.0,"discounted_cash":2388.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.61,"discounted_cash":2420.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5325.85,"discounted_cash":2662.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6444.36,"discounted_cash":3222.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343876","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7088.82,"discounted_cash":3544.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7797.77,"discounted_cash":3898.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8577.59,"discounted_cash":4288.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343879","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9435.39,"discounted_cash":4717.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343880","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10378.96,"discounted_cash":5189.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343882","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11757.06,"discounted_cash":5878.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343883","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12932.79,"discounted_cash":6466.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14226.12,"discounted_cash":7113.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343886","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17213.68,"discounted_cash":8606.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343887","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":18935.09,"discounted_cash":9467.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02343888","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":20828.68,"discounted_cash":10414.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343894","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2424.02,"discounted_cash":1212.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343895","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2666.46,"discounted_cash":1333.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343896","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2719.83,"discounted_cash":1359.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2991.86,"discounted_cash":1495.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343898","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3291.08,"discounted_cash":1645.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3620.24,"discounted_cash":1810.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343900","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3982.34,"discounted_cash":1991.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4380.59,"discounted_cash":2190.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343902","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4818.74,"discounted_cash":2409.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5373.46,"discounted_cash":2686.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343905","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5910.86,"discounted_cash":2955.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6501.98,"discounted_cash":3250.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7867.47,"discounted_cash":3933.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8654.3,"discounted_cash":4327.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9519.76,"discounted_cash":4759.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343911_71910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10471.79,"discounted_cash":5235.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02343911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10471.79,"discounted_cash":5235.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11519.0,"discounted_cash":5759.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11862.18,"discounted_cash":5931.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343915","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14353.33,"discounted_cash":7176.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343916","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15788.7,"discounted_cash":7894.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19104.4,"discounted_cash":9552.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21014.88,"discounted_cash":10507.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":23116.44,"discounted_cash":11558.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02343922","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":25428.12,"discounted_cash":12714.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reload","code_information":[{"code":"02343929","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2721.86,"discounted_cash":1360.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Allograft","code_information":[{"code":"02343939","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5202.0,"discounted_cash":2601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrodes Neurotherm","code_information":[{"code":"02343940","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":645.66,"discounted_cash":322.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Neuroform","code_information":[{"code":"02343951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":40329.86,"discounted_cash":20164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Viabahn Endoprosthesis","code_information":[{"code":"02343955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":25493.9,"discounted_cash":12746.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02343960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Syringe Inflation","code_information":[{"code":"02343961_39109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":952.38,"discounted_cash":476.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Syringe Inflation","code_information":[{"code":"02343961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":952.38,"discounted_cash":476.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plug Vascular","code_information":[{"code":"02343965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5657.6,"discounted_cash":2828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Embolectomy","code_information":[{"code":"02343970","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":923.52,"discounted_cash":461.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.05,"discounted_cash":1810.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02343973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3983.2,"discounted_cash":1991.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgical Driver Battery Ster","code_information":[{"code":"02343978","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1589.45,"discounted_cash":794.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02343979","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2240.5,"discounted_cash":1120.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Button Suture","code_information":[{"code":"02343983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1227.17,"discounted_cash":613.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Sleeve Centering","code_information":[{"code":"02343993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.4,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meniscal Repair System","code_information":[{"code":"02344004","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2442.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Coronary","code_information":[{"code":"02344007","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":16195.5,"discounted_cash":8097.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344013","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.11,"discounted_cash":1331.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.41,"discounted_cash":1357.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.0,"discounted_cash":1493.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344018","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3975.86,"discounted_cash":1987.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344019","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4373.51,"discounted_cash":2186.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4810.88,"discounted_cash":2405.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344021","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4877.0,"discounted_cash":2438.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5364.72,"discounted_cash":2682.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344023","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5901.27,"discounted_cash":2950.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344024","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6491.41,"discounted_cash":3245.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_69262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_72660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_74014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_74864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_75630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_79990","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_83022","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_86262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_86355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344025_87030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7854.73,"discounted_cash":3927.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344027","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8640.25,"discounted_cash":4320.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9504.29,"discounted_cash":4752.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344029","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10454.77,"discounted_cash":5227.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344030","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11500.34,"discounted_cash":5750.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11842.91,"discounted_cash":5921.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13027.26,"discounted_cash":6513.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14330.01,"discounted_cash":7165.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15763.09,"discounted_cash":7881.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344035","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17339.43,"discounted_cash":8669.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344036_129697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19073.43,"discounted_cash":9536.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19073.43,"discounted_cash":9536.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":20980.78,"discounted_cash":10490.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":20980.84,"discounted_cash":10490.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":23078.96,"discounted_cash":11539.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":25386.88,"discounted_cash":12693.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344041","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":27925.64,"discounted_cash":13962.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344042","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":30718.24,"discounted_cash":15359.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":33790.08,"discounted_cash":16895.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":37169.12,"discounted_cash":18584.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":39863.93,"discounted_cash":19931.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02344046","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":43850.35,"discounted_cash":21925.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344049","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2200.0,"discounted_cash":1100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2662.11,"discounted_cash":1331.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344052","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2715.39,"discounted_cash":1357.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344053","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2987.02,"discounted_cash":1493.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25498","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25505","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_25508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054_63105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3285.78,"discounted_cash":1642.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3614.37,"discounted_cash":1807.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3975.86,"discounted_cash":1987.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344057","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4373.51,"discounted_cash":2186.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4810.88,"discounted_cash":2405.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344059","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4877.0,"discounted_cash":2438.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5364.72,"discounted_cash":2682.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344061","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5901.27,"discounted_cash":2950.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344062","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6491.41,"discounted_cash":3245.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344063","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7140.62,"discounted_cash":3570.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7854.73,"discounted_cash":3927.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8640.25,"discounted_cash":4320.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344066","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9504.29,"discounted_cash":4752.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10454.77,"discounted_cash":5227.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11500.34,"discounted_cash":5750.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344069","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11842.91,"discounted_cash":5921.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13027.26,"discounted_cash":6513.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344071","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14330.01,"discounted_cash":7165.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344072","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15763.09,"discounted_cash":7881.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344073","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":17339.43,"discounted_cash":8669.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344074","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19073.43,"discounted_cash":9536.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344075","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":20980.78,"discounted_cash":10490.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":20980.84,"discounted_cash":10490.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02344077","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":23078.96,"discounted_cash":11539.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344091","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.79,"discounted_cash":805.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344092","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.88,"discounted_cash":885.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2594.52,"discounted_cash":1297.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2646.44,"discounted_cash":1323.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344100","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3522.57,"discounted_cash":1761.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344101","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3874.88,"discounted_cash":1937.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344102","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4262.43,"discounted_cash":2131.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4688.69,"discounted_cash":2344.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344104","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4753.11,"discounted_cash":2376.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344106","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5751.34,"discounted_cash":2875.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6326.53,"discounted_cash":3163.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344108","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6959.24,"discounted_cash":3479.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344109","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7655.22,"discounted_cash":3827.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344110","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8420.8,"discounted_cash":4210.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_113909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_87031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_87270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_87343","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_88374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111_88885","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344111","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9262.9,"discounted_cash":4631.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10189.22,"discounted_cash":5094.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344113","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11208.23,"discounted_cash":5604.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344114","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11542.12,"discounted_cash":5771.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344115","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12696.38,"discounted_cash":6348.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344116","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13966.04,"discounted_cash":6983.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15362.73,"discounted_cash":7681.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16899.04,"discounted_cash":8449.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Insert","code_information":[{"code":"02344123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":24742.12,"discounted_cash":12371.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344127_25590","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.11,"discounted_cash":665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344127_62391","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.11,"discounted_cash":665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344127_94416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.11,"discounted_cash":665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344127_96756","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.11,"discounted_cash":665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344127","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1331.11,"discounted_cash":665.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344129","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1610.79,"discounted_cash":805.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1771.88,"discounted_cash":885.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344132_88837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.12,"discounted_cash":1072.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.12,"discounted_cash":1072.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344136","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2911.13,"discounted_cash":1455.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3522.57,"discounted_cash":1761.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3874.88,"discounted_cash":1937.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4688.69,"discounted_cash":2344.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4753.11,"discounted_cash":2376.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344143_129698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5228.47,"discounted_cash":2614.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5228.47,"discounted_cash":2614.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6959.24,"discounted_cash":3479.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10189.22,"discounted_cash":5094.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11208.23,"discounted_cash":5604.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02344155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15362.73,"discounted_cash":7681.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Tissue","code_information":[{"code":"02344165","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8110.08,"discounted_cash":4055.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02344177","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.2,"discounted_cash":361.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knife Arthroscopic","code_information":[{"code":"02344194","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1655.9,"discounted_cash":827.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Brace Hip Abductor","code_information":[{"code":"02344207_74245","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1686","type":"HCPCS"}],"standard_charges":[{"gross_charge":5756.47,"discounted_cash":2878.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Brace Hip Abductor","code_information":[{"code":"02344207","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1686","type":"HCPCS"}],"standard_charges":[{"gross_charge":5756.47,"discounted_cash":2878.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial Wedge","code_information":[{"code":"02344216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12384.0,"discounted_cash":6192.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sub Skin Dermal Matrix","code_information":[{"code":"02344218","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":31354.4,"discounted_cash":15677.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02344221","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":4930.0,"discounted_cash":2465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Long Handle Laa System","code_information":[{"code":"02344233","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Gentamicin","code_information":[{"code":"02344246_103138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.8,"discounted_cash":580.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cement Gentamicin","code_information":[{"code":"02344246","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1161.8,"discounted_cash":580.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Endo","code_information":[{"code":"02344251","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3093.2,"discounted_cash":1546.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Brace Knee Cool Trom Advance","code_information":[{"code":"02344255","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1810","type":"HCPCS"}],"standard_charges":[{"gross_charge":716.16,"discounted_cash":358.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02344258","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1080.4,"discounted_cash":540.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath Peal Away","code_information":[{"code":"02344266","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.15,"discounted_cash":199.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor","code_information":[{"code":"02344267_74854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":675.1,"discounted_cash":337.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Retractor","code_information":[{"code":"02344267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":680.6,"discounted_cash":340.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Locator Interoperative","code_information":[{"code":"02344269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7033.6,"discounted_cash":3516.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Polar Care Cube","code_information":[{"code":"02344274_3582542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":484.42,"discounted_cash":242.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Polar Care Cube","code_information":[{"code":"02344274_75004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":494.39,"discounted_cash":247.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Polar Care Cube","code_information":[{"code":"02344274","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":484.42,"discounted_cash":242.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealer Ligasure","code_information":[{"code":"02344285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3034.0,"discounted_cash":1517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02344289","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1911.42,"discounted_cash":955.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Long Handle","code_information":[{"code":"02344293","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6120.0,"discounted_cash":3060.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Smoother Gore","code_information":[{"code":"02344295","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2296.96,"discounted_cash":1148.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealant Progel Pleural","code_information":[{"code":"02344300","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7530.88,"discounted_cash":3765.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suturelasso Fishhook","code_information":[{"code":"02344321_3602672","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suturelasso Fishhook","code_information":[{"code":"02344321_76895","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suturelasso Fishhook","code_information":[{"code":"02344321","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft S Tiss Strattice 15X25","code_information":[{"code":"02344345","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4130","type":"HCPCS"}],"standard_charges":[{"gross_charge":70739.1,"discounted_cash":35369.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealing Vessel Ligasure","code_information":[{"code":"02344351_102690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4126.85,"discounted_cash":2063.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sealing Vessel Ligasure","code_information":[{"code":"02344351_3582026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4126.85,"discounted_cash":2063.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealing Vessel Ligasure","code_information":[{"code":"02344351_95225","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4159.33,"discounted_cash":2079.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sealing Vessel Ligasure","code_information":[{"code":"02344351_97515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4206.17,"discounted_cash":2103.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sealing Vessel Ligasure","code_information":[{"code":"02344351","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4126.85,"discounted_cash":2063.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Microdelivery","code_information":[{"code":"02344357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5638.22,"discounted_cash":2819.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Biventricular","code_information":[{"code":"02344358","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":38640.0,"discounted_cash":19320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Achilles Tendon","code_information":[{"code":"02344363","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8390.4,"discounted_cash":4195.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Coring And Collared","code_information":[{"code":"02344365_101809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Reamer Coring And Collared","code_information":[{"code":"02344365","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bowel Mgmt System Signal","code_information":[{"code":"02344369","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02344374","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3696.0,"discounted_cash":1848.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath","code_information":[{"code":"02344378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1094.46,"discounted_cash":547.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Vascular Closure","code_information":[{"code":"02344395","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":758.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hook Cautery Device","code_information":[{"code":"02344398_130428","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1762.74,"discounted_cash":881.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hook Cautery Device","code_information":[{"code":"02344398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1762.74,"discounted_cash":881.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ablation Hydrothermal Syst","code_information":[{"code":"02344399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11098.61,"discounted_cash":5549.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuromend Collagn Nrv Wrap 5Cm","code_information":[{"code":"02344400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9361","type":"HCPCS"}],"standard_charges":[{"gross_charge":11328.0,"discounted_cash":5664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Eea Circular Powered","code_information":[{"code":"02344402_105391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8736.33,"discounted_cash":4368.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Eea Circular Powered","code_information":[{"code":"02344402","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9059.86,"discounted_cash":4529.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple Caudal","code_information":[{"code":"02344403_128973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8928.0,"discounted_cash":4464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple Caudal","code_information":[{"code":"02344403","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10411.2,"discounted_cash":5205.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Hydrosoft","code_information":[{"code":"02344422","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9792.0,"discounted_cash":4896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Da Vinci Sureform 60","code_information":[{"code":"02344429","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3534.87,"discounted_cash":1767.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embolization Protective System","code_information":[{"code":"02344439","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02344440","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":7616.0,"discounted_cash":3808.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02344443","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12800.0,"discounted_cash":6400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02344448","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":7145.6,"discounted_cash":3572.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02344450","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Kypho Onestep","code_information":[{"code":"02344454","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Repair Device Urinary W/Sling","code_information":[{"code":"02344456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":6421.24,"discounted_cash":3210.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachable Target","code_information":[{"code":"02344458","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13600.0,"discounted_cash":6800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachable Target","code_information":[{"code":"02344459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13645.44,"discounted_cash":6822.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachable Target Soft","code_information":[{"code":"02344460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13645.44,"discounted_cash":6822.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachable Target Ultra","code_information":[{"code":"02344461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9096.96,"discounted_cash":4548.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Inzone Detach System","code_information":[{"code":"02344462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1753.06,"discounted_cash":876.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostatic Powder Arista","code_information":[{"code":"02344495_3601999","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":906.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostatic Powder Arista","code_information":[{"code":"02344495_76700","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":906.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hemostatic Powder Arista","code_information":[{"code":"02344495","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":906.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rumi Koh Efficient","code_information":[{"code":"02344509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1260.89,"discounted_cash":630.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Natural Tissue Denovo","code_information":[{"code":"02344514","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29390.85,"discounted_cash":14695.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Electrophysiology","code_information":[{"code":"02344517","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":10720.0,"discounted_cash":5360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste","code_information":[{"code":"02344519","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.8,"discounted_cash":266.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accupass Shuttle","code_information":[{"code":"02344521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1000.7,"discounted_cash":500.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor","code_information":[{"code":"02344529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.95,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02344533","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":11808.0,"discounted_cash":5904.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embosphere Syringe","code_information":[{"code":"02344536","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.2,"discounted_cash":899.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith Spiral Iliac","code_information":[{"code":"02344543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":27435.0,"discounted_cash":13717.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Perimount Aortic Biopros","code_information":[{"code":"02344544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":25370.0,"discounted_cash":12685.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heart Valve Aortic Asc Pros","code_information":[{"code":"02344553","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":31052.0,"discounted_cash":15526.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft","code_information":[{"code":"02344556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xlif Retractor Kit","code_information":[{"code":"02344582","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6429.18,"discounted_cash":3214.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Filter Vena Cava Retrieval","code_information":[{"code":"02344587","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":2602.95,"discounted_cash":1301.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344601","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1617.99,"discounted_cash":809.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2369.18,"discounted_cash":1184.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2606.18,"discounted_cash":1303.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344607","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2658.32,"discounted_cash":1329.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2924.24,"discounted_cash":1462.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3538.43,"discounted_cash":1769.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344611","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3892.32,"discounted_cash":1946.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4281.6,"discounted_cash":2140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344613","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4709.8,"discounted_cash":2354.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4774.5,"discounted_cash":2387.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5251.97,"discounted_cash":2625.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344617","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6355.01,"discounted_cash":3177.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8458.64,"discounted_cash":4229.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9304.59,"discounted_cash":4652.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10235.1,"discounted_cash":5117.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11594.04,"discounted_cash":5797.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12753.49,"discounted_cash":6376.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14028.87,"discounted_cash":7014.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15431.81,"discounted_cash":7715.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16975.02,"discounted_cash":8487.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02344629","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18672.59,"discounted_cash":9336.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02344635","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2708.1,"discounted_cash":1354.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02344639","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.15,"discounted_cash":1982.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02344643","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5350.29,"discounted_cash":2675.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02344646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7121.39,"discounted_cash":3560.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02344648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8616.99,"discounted_cash":4308.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.0,"discounted_cash":357.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":786.56,"discounted_cash":393.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":865.26,"discounted_cash":432.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":951.83,"discounted_cash":475.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1047.09,"discounted_cash":523.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.09,"discounted_cash":633.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1686.7,"discounted_cash":843.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1855.43,"discounted_cash":927.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2716.73,"discounted_cash":1358.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2771.14,"discounted_cash":1385.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3353.2,"discounted_cash":1676.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344670","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4057.46,"discounted_cash":2028.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4909.62,"discounted_cash":2454.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6022.35,"discounted_cash":3011.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344676","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6624.65,"discounted_cash":3312.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02344682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11736.28,"discounted_cash":5868.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Occlusion","code_information":[{"code":"02344700","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2477.15,"discounted_cash":1238.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Jejunostomy","code_information":[{"code":"02344703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3780.8,"discounted_cash":1890.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02344712","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manipulator Endoscopic","code_information":[{"code":"02344718_127121","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":663.01,"discounted_cash":331.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Manipulator Endoscopic","code_information":[{"code":"02344718","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":705.59,"discounted_cash":352.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith Iliac","code_information":[{"code":"02344728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15411.2,"discounted_cash":7705.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary","code_information":[{"code":"02344730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1213.6,"discounted_cash":606.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Mix Kit","code_information":[{"code":"02344743","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.08,"discounted_cash":384.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meniscal Suture","code_information":[{"code":"02344749","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3182.0,"discounted_cash":1591.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knot Pusher Cannula Set","code_information":[{"code":"02344750","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1028.97,"discounted_cash":514.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cancellous","code_information":[{"code":"02344758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6732.0,"discounted_cash":3366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344765_125567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7248.0,"discounted_cash":3624.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344765_126673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7268.13,"discounted_cash":3634.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7200.0,"discounted_cash":3600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344766","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.4,"discounted_cash":3315.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344766_101371","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6910.78,"discounted_cash":3455.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Toe Implant","code_information":[{"code":"02344766_128798","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6910.78,"discounted_cash":3455.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Coronary Sinus","code_information":[{"code":"02344769","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":13440.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee End Cap","code_information":[{"code":"02344770","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1944.72,"discounted_cash":972.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02344773","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":80190.0,"discounted_cash":40095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344777","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6255.84,"discounted_cash":3127.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344778","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6881.51,"discounted_cash":3440.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8326.71,"discounted_cash":4163.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9159.41,"discounted_cash":4579.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10075.39,"discounted_cash":5037.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11082.98,"discounted_cash":5541.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344784","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11413.16,"discounted_cash":5706.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344785","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12554.52,"discounted_cash":6277.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16710.23,"discounted_cash":8355.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":18381.31,"discounted_cash":9190.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":20219.45,"discounted_cash":10109.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344791","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":20219.52,"discounted_cash":10109.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344792","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22241.48,"discounted_cash":11120.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02344794","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":26912.28,"discounted_cash":13456.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ultrasound","code_information":[{"code":"02344804","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":17292.9,"discounted_cash":8646.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guide Acuity","code_information":[{"code":"02344807","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer","code_information":[{"code":"02344809","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary","code_information":[{"code":"02344822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4732.8,"discounted_cash":2366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02344831","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":11808.0,"discounted_cash":5904.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste Dbm","code_information":[{"code":"02344835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02344839","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":82075.0,"discounted_cash":41037.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02344840","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":62328.0,"discounted_cash":31164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02344841","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":65826.0,"discounted_cash":32913.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02344854","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1124.8,"discounted_cash":562.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02344865","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Dural Graft","code_information":[{"code":"02344867","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3409.18,"discounted_cash":1704.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Cricothyrotomy","code_information":[{"code":"02344871","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2565.58,"discounted_cash":1282.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patch External","code_information":[{"code":"02344879","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Progel Extended Spray Tip","code_information":[{"code":"02344881","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1234.32,"discounted_cash":617.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Magnifuse","code_information":[{"code":"02344890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occlusion Coil Idc","code_information":[{"code":"02344892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4284.0,"discounted_cash":2142.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dearterialization Kit","code_information":[{"code":"02344900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3736.6,"discounted_cash":1868.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cor-Knot Quick Loads","code_information":[{"code":"02344902","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Magnifuse","code_information":[{"code":"02344903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14976.0,"discounted_cash":7488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02344908","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.8,"discounted_cash":1450.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Versa-Kath","code_information":[{"code":"02344909","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":611.2,"discounted_cash":305.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Defib Endo Dual Coil","code_information":[{"code":"02344927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1895","type":"HCPCS"}],"standard_charges":[{"gross_charge":20060.0,"discounted_cash":10030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Atherectomy Device","code_information":[{"code":"02344939","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20030.5,"discounted_cash":10015.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suction Endowrist Irrigator","code_information":[{"code":"02344953_100834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2059.67,"discounted_cash":1029.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suction Endowrist Irrigator","code_information":[{"code":"02344953","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2059.67,"discounted_cash":1029.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostat Absorbable","code_information":[{"code":"02344959","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1398.86,"discounted_cash":699.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Pain","code_information":[{"code":"02344986","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":15648.0,"discounted_cash":7824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Vial And Drape Spy Elite","code_information":[{"code":"02344991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02345002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15640.0,"discounted_cash":7820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr 5.5 Abrader","code_information":[{"code":"02345004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2893.4,"discounted_cash":1446.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Neurostimulator","code_information":[{"code":"02345012","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alignment Guide Prophecy","code_information":[{"code":"02345031","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Swing Tip Ercp","code_information":[{"code":"02345034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1265.62,"discounted_cash":632.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Endoreturn Arterial","code_information":[{"code":"02345045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3404.0,"discounted_cash":1702.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Screwdriver","code_information":[{"code":"02345082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5168.0,"discounted_cash":2584.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mobile Charging System","code_information":[{"code":"02345088_74890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mobile Charging System","code_information":[{"code":"02345088","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Central Venous Cath Port Quad","code_information":[{"code":"02345090_79805","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.8,"discounted_cash":525.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Central Venous Cath Port Quad","code_information":[{"code":"02345090","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.8,"discounted_cash":525.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Needle Express","code_information":[{"code":"02345093","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1620.6,"discounted_cash":810.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Matrix 10 Cc","code_information":[{"code":"02345096","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":26204.85,"discounted_cash":13102.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Cellentra 5 Cc","code_information":[{"code":"02345099","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12825.6,"discounted_cash":6412.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Cellentra 10 Cc","code_information":[{"code":"02345103","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":21529.1,"discounted_cash":10764.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spike Belmont System","code_information":[{"code":"02345114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1314.73,"discounted_cash":657.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cutter Attachment","code_information":[{"code":"02345117","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1438.86,"discounted_cash":719.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02345130","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2160.8,"discounted_cash":1080.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Bone Marrow Asp","code_information":[{"code":"02345138","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":794.02,"discounted_cash":397.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cassette Vac Veralink For Ulta","code_information":[{"code":"02345142","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":433.65,"discounted_cash":216.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Canister For Vac Ulta","code_information":[{"code":"02345143","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":415.64,"discounted_cash":207.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Med Vac Veraflow Ulta","code_information":[{"code":"02345144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":787.82,"discounted_cash":393.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scissors","code_information":[{"code":"02345148","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.4,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Scepter","code_information":[{"code":"02345151","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8840.0,"discounted_cash":4420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Scepter","code_information":[{"code":"02345152","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Open Abdomen","code_information":[{"code":"02345156","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3540.16,"discounted_cash":1770.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler","code_information":[{"code":"02345158_106703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler","code_information":[{"code":"02345158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plug Spine","code_information":[{"code":"02345162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Nerve Avance","code_information":[{"code":"02345169","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15428.5,"discounted_cash":7714.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Xact Carotid","code_information":[{"code":"02345173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":13158.4,"discounted_cash":6579.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Vaccess Pta Dilation","code_information":[{"code":"02345176","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":920.34,"discounted_cash":460.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Export","code_information":[{"code":"02345180_80377","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Export","code_information":[{"code":"02345180","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chip Cancellous","code_information":[{"code":"02345189","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3944.0,"discounted_cash":1972.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw Set","code_information":[{"code":"02345190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1198.8,"discounted_cash":599.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345192","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3315.0,"discounted_cash":1657.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3646.55,"discounted_cash":1823.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4412.42,"discounted_cash":2206.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345196","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4853.72,"discounted_cash":2426.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345203","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8717.14,"discounted_cash":4358.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9588.89,"discounted_cash":4794.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11602.66,"discounted_cash":5801.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13143.2,"discounted_cash":6571.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345211","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":17493.74,"discounted_cash":8746.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19243.18,"discounted_cash":9621.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":21167.56,"discounted_cash":10583.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345215_119315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":23284.36,"discounted_cash":11642.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345215","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":23284.36,"discounted_cash":11642.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Spacer","code_information":[{"code":"02345216","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":25612.84,"discounted_cash":12806.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guide Sinus Relieva","code_information":[{"code":"02345226","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2567.8,"discounted_cash":1283.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bolt","code_information":[{"code":"02345244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3300.03,"discounted_cash":1650.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1790.95,"discounted_cash":895.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1970.1,"discounted_cash":985.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2167.24,"discounted_cash":1083.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2383.98,"discounted_cash":1191.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3490.8,"discounted_cash":1745.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345315_107353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4696.76,"discounted_cash":2348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345315","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4696.76,"discounted_cash":2348.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5166.5,"discounted_cash":2583.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5683.24,"discounted_cash":2841.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6472.32,"discounted_cash":3236.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7119.62,"discounted_cash":3559.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345322_109856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8614.85,"discounted_cash":4307.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345322_128753","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8614.85,"discounted_cash":4307.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345322_129366","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8614.85,"discounted_cash":4307.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8614.85,"discounted_cash":4307.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9476.42,"discounted_cash":4738.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345324_127960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10424.13,"discounted_cash":5212.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345324_C1713_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10424.13,"discounted_cash":5212.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10424.13,"discounted_cash":5212.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345325","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11466.62,"discounted_cash":5733.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12613.31,"discounted_cash":6306.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345327_129482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13874.69,"discounted_cash":6937.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345327_130395","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13874.69,"discounted_cash":6937.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345327","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13874.69,"discounted_cash":6937.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345328","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15262.27,"discounted_cash":7631.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15476.94,"discounted_cash":7738.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345330_107354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17024.69,"discounted_cash":8512.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345330_130489","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17024.69,"discounted_cash":8512.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02345330","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17024.69,"discounted_cash":8512.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18727.19,"discounted_cash":9363.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345334","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24926.14,"discounted_cash":12463.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345335","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":27418.78,"discounted_cash":13709.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02345336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28627.14,"discounted_cash":14313.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopic Instruments Disposable","code_information":[{"code":"02345337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1538.46,"discounted_cash":769.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent E-Luminexx","code_information":[{"code":"02345357","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Sinus Guide Relieva","code_information":[{"code":"02345366","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2242.2,"discounted_cash":1121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Kyphopak","code_information":[{"code":"02345369","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Catheter","code_information":[{"code":"02345377","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":943.5,"discounted_cash":471.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remover Foreign Body","code_information":[{"code":"02345382","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Posterior Tibialis","code_information":[{"code":"02345387","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8160.0,"discounted_cash":4080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Anchor Bumpy","code_information":[{"code":"02345398","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2597.4,"discounted_cash":1298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath","code_information":[{"code":"02345407","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":765.38,"discounted_cash":382.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules","code_information":[{"code":"02345413","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3170.16,"discounted_cash":1585.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Barrx","code_information":[{"code":"02345414","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11827.2,"discounted_cash":5913.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Barrx Ballon 18-31 Ultra Halo","code_information":[{"code":"02345417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9324.8,"discounted_cash":4662.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Extr Short Wire","code_information":[{"code":"02345427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1105.19,"discounted_cash":552.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent W Delivery System","code_information":[{"code":"02345428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.3,"discounted_cash":497.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Double Pigtail Pushing","code_information":[{"code":"02345429","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":646.6,"discounted_cash":323.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Double Pigtail 5-10Cm","code_information":[{"code":"02345430","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.11,"discounted_cash":217.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forcep Spy Bite","code_information":[{"code":"02345433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3554.9,"discounted_cash":1777.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dream Tome","code_information":[{"code":"02345438","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3070.93,"discounted_cash":1535.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basket Mini","code_information":[{"code":"02345439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2360.6,"discounted_cash":1180.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chip Cancellous","code_information":[{"code":"02345445","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Laser Sheath","code_information":[{"code":"02345447","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":18378.5,"discounted_cash":9189.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plasma Peak Blade","code_information":[{"code":"02345448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02345450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8620.8,"discounted_cash":4310.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps Rescue","code_information":[{"code":"02345457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":687.27,"discounted_cash":343.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Autotome","code_information":[{"code":"02345459","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1587.82,"discounted_cash":793.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary 12-15Cm","code_information":[{"code":"02345460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":434.11,"discounted_cash":217.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Exchanger Broncocath","code_information":[{"code":"02345462","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":723.77,"discounted_cash":361.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Advanced Delivery System","code_information":[{"code":"02345463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1504.67,"discounted_cash":752.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Maxcutter","code_information":[{"code":"02345464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1308.1,"discounted_cash":654.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forcep Coagrasper","code_information":[{"code":"02345465","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Protector","code_information":[{"code":"02345490","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15264.0,"discounted_cash":7632.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Osteochondral","code_information":[{"code":"02345491","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22597.0,"discounted_cash":11298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Axoguard Nerve Protector","code_information":[{"code":"02345508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":17228.0,"discounted_cash":8614.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Apligraf 44 Cm","code_information":[{"code":"02345516","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4101","type":"HCPCS"}],"standard_charges":[{"gross_charge":8160.0,"discounted_cash":4080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Soft Tissue Visicoil","code_information":[{"code":"02345517","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Wedge","code_information":[{"code":"02345518","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11856.0,"discounted_cash":5928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Injector Ii Cartridge","code_information":[{"code":"02345529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1768.23,"discounted_cash":884.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02345534","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":29495.2,"discounted_cash":14747.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Erbejet Pump Cartridge","code_information":[{"code":"02345536","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":895.4,"discounted_cash":447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Navien Intracranial","code_information":[{"code":"02345540","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9216.0,"discounted_cash":4608.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Intracranial","code_information":[{"code":"02345541","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6390.37,"discounted_cash":3195.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transport Cannula","code_information":[{"code":"02345542","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cresent Nanopass","code_information":[{"code":"02345543","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1732.27,"discounted_cash":866.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Max Aspiration Tubing","code_information":[{"code":"02345558","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02345566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11872.0,"discounted_cash":5936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Cellentra 15 Cc","code_information":[{"code":"02345571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":26048.5,"discounted_cash":13024.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Flowport Kit","code_information":[{"code":"02345575","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2367.63,"discounted_cash":1183.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Erbejet 2 Applicator","code_information":[{"code":"02345577_82254","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4063.0,"discounted_cash":2031.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Erbejet 2 Applicator","code_information":[{"code":"02345577","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4063.0,"discounted_cash":2031.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Neurostimulator","code_information":[{"code":"02345581","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2501.2,"discounted_cash":1250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Button Suture","code_information":[{"code":"02345585_82326","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Button Suture","code_information":[{"code":"02345585","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Instrument Tracker","code_information":[{"code":"02345590","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1165.35,"discounted_cash":582.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Joint Finger Silicone","code_information":[{"code":"02345600","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8908.48,"discounted_cash":4454.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wound Matrix Bilayer 4X5","code_information":[{"code":"02345601","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"gross_charge":32028.3,"discounted_cash":16014.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Casting Boot Tcc-Ez Regular","code_information":[{"code":"02345606_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.65,"discounted_cash":270.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Casting Boot Tcc-Ez Regular","code_information":[{"code":"02345606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.65,"discounted_cash":270.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Diamond Head","code_information":[{"code":"02345609","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1063.68,"discounted_cash":531.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stay Blunt Hook","code_information":[{"code":"02345615","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":571.95,"discounted_cash":285.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Inflation Disp","code_information":[{"code":"02345617","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transfer Set Echosight","code_information":[{"code":"02345618","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":573.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Triple Lumen Retrieval Balloon","code_information":[{"code":"02345636","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1105.19,"discounted_cash":552.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02345647_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":110.76,"discounted_cash":55.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Decapolar","code_information":[{"code":"02345653","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1731","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachable Target","code_information":[{"code":"02345655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16744.55,"discounted_cash":8372.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02345658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15200.0,"discounted_cash":7600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Encompass Reamer","code_information":[{"code":"02345660","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4012.0,"discounted_cash":2006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lubricant Cardiovascular","code_information":[{"code":"02345664","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Extender","code_information":[{"code":"02345667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02345671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":15487.5,"discounted_cash":7743.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02345672","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.13,"discounted_cash":436.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02345674","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4356.28,"discounted_cash":2178.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02345675","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":68093.34,"discounted_cash":34046.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Ureteral Access","code_information":[{"code":"02345685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":871.5,"discounted_cash":435.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Uromax","code_information":[{"code":"02345686","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1943.54,"discounted_cash":971.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Neurostimulator","code_information":[{"code":"02345698","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Neurostimulator","code_information":[{"code":"02345698_66705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Collector Cervical Bone","code_information":[{"code":"02345703","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":527.91,"discounted_cash":263.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Collector Lumbar Bone","code_information":[{"code":"02345704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":954.53,"discounted_cash":477.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidepin","code_information":[{"code":"02345707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":937.51,"discounted_cash":468.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthroscopy Instrument Kit","code_information":[{"code":"02345714_83179","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Arthroscopy Instrument Kit","code_information":[{"code":"02345714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02345715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":9408.0,"discounted_cash":4704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02345718","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vascular Retrieval Kit","code_information":[{"code":"02345723","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02345728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18261.09,"discounted_cash":9130.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Flowport Kit","code_information":[{"code":"02345731","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3075.81,"discounted_cash":1537.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pencil Bayonette Electrosurgical","code_information":[{"code":"02345735","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":832.5,"discounted_cash":416.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp","code_information":[{"code":"02345736","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4468.14,"discounted_cash":2234.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp","code_information":[{"code":"02345737","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4885.94,"discounted_cash":2442.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc External Fixation Rod","code_information":[{"code":"02345738","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3174.82,"discounted_cash":1587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc External Fixation Rod","code_information":[{"code":"02345739","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2635.36,"discounted_cash":1317.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plasma Blade Peak","code_information":[{"code":"02345742","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2449.4,"discounted_cash":1224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Substitute","code_information":[{"code":"02345751","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoanalgesia Smart Tip Iovera","code_information":[{"code":"02345753","type":"CDM"},{"code":"272","type":"RC"},{"code":"C9809","type":"HCPCS"}],"standard_charges":[{"gross_charge":5436.6,"discounted_cash":2718.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Insertion Tool","code_information":[{"code":"02345758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Markers Cobra","code_information":[{"code":"02345769","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.24,"discounted_cash":934.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Delivery Kit","code_information":[{"code":"02345770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":947.2,"discounted_cash":473.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02345773_117786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2079.4,"discounted_cash":1039.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Reamer","code_information":[{"code":"02345773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2079.4,"discounted_cash":1039.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02345776_116163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14784.0,"discounted_cash":7392.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02345776","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14092.8,"discounted_cash":7046.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Control Valve","code_information":[{"code":"02345783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":31479.62,"discounted_cash":15739.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostatic Powder Arista","code_information":[{"code":"02345787","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1317.2,"discounted_cash":658.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneling Tool","code_information":[{"code":"02345793","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.4,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02345812","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2480.85,"discounted_cash":1240.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02345825","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1272.8,"discounted_cash":636.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cup Reamer","code_information":[{"code":"02345826","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1924.0,"discounted_cash":962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Eus Replacement","code_information":[{"code":"02345829","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2591.48,"discounted_cash":1295.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith Aaa Custom","code_information":[{"code":"02345834","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":27582.5,"discounted_cash":13791.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith Aaa Custom","code_information":[{"code":"02345835","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":72217.8,"discounted_cash":36108.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02345836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02345837","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6432.8,"discounted_cash":3216.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345844","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.78,"discounted_cash":208.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345845","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":459.7,"discounted_cash":229.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345846_34799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.7,"discounted_cash":252.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345846_91077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.7,"discounted_cash":252.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345846","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":505.7,"discounted_cash":252.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345847_128531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":556.33,"discounted_cash":278.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345847","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":556.33,"discounted_cash":278.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_106334","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_108174","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_128425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_56020","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_71774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_73908","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_91076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_93527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848_93528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.06,"discounted_cash":306.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345849_43410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":673.37,"discounted_cash":336.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345849_72647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":673.37,"discounted_cash":336.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":673.37,"discounted_cash":336.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850_127218","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850_129919","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850_3586650","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850_73909","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850_91877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345850","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.8,"discounted_cash":370.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345851_130517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":768.19,"discounted_cash":384.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345851_36170","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":768.19,"discounted_cash":384.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345851_71774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":768.19,"discounted_cash":384.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345851","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":768.19,"discounted_cash":384.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345852_124671","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":845.08,"discounted_cash":422.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345852_63076","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":845.08,"discounted_cash":422.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345852_72647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":845.08,"discounted_cash":422.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":845.08,"discounted_cash":422.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_118583","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_124012","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_131008","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_64181","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_64182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853_83141","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345853","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":929.74,"discounted_cash":464.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1022.75,"discounted_cash":511.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345855_110646","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.1,"discounted_cash":562.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345855_128532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.1,"discounted_cash":562.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345855_3586763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.1,"discounted_cash":562.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345855_77527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.1,"discounted_cash":562.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345855","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1125.1,"discounted_cash":562.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_100137","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_130205","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_3585485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_3585486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_3610847","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_3610961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_80212","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_93213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_93214","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_96617","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_97848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_99478","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856_99482","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1237.65,"discounted_cash":618.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345857_125676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1361.53,"discounted_cash":680.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345857_126421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1361.53,"discounted_cash":680.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345857","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1361.53,"discounted_cash":680.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345858_101021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.76,"discounted_cash":748.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345858_102426","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.76,"discounted_cash":748.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345858_115400","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.76,"discounted_cash":748.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.76,"discounted_cash":748.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345858_123408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1497.76,"discounted_cash":748.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859_129243","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859_129249","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859_129404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859_129834","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859_129835","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1647.61,"discounted_cash":823.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345860_125669","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1812.41,"discounted_cash":906.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345860_127991","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1812.41,"discounted_cash":906.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345860_127992","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1812.41,"discounted_cash":906.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345860_129396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1812.41,"discounted_cash":906.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1812.41,"discounted_cash":906.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861_117463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861_128045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861_129487","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861_129488","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861_93949","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345861","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1993.71,"discounted_cash":996.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345862","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2193.21,"discounted_cash":1096.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345863_109921","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2412.55,"discounted_cash":1206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345863","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2412.55,"discounted_cash":1206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345863_126396","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2412.55,"discounted_cash":1206.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345864","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2653.94,"discounted_cash":1326.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345865_106866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2919.37,"discounted_cash":1459.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2919.37,"discounted_cash":1459.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345866_63979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3211.38,"discounted_cash":1605.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3211.38,"discounted_cash":1605.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345867_78597","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3532.61,"discounted_cash":1766.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3532.61,"discounted_cash":1766.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345868","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.88,"discounted_cash":1785.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345869_129911","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3928.02,"discounted_cash":1964.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345869_3586905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3928.02,"discounted_cash":1964.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345869_85110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3928.02,"discounted_cash":1964.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345869","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3928.02,"discounted_cash":1964.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02345870","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4320.86,"discounted_cash":2160.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02345878","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.76,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02345881","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.76,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02345889","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1836.83,"discounted_cash":918.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02345894","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilation","code_information":[{"code":"02345895","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02345896","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02345897","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02345897_73759","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02345898","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3381.43,"discounted_cash":1690.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02345903","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1975.36,"discounted_cash":987.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02345911","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02345913","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":988.05,"discounted_cash":494.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps Bovie Tip","code_information":[{"code":"02345914","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3871.85,"discounted_cash":1935.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02345922","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":71942.2,"discounted_cash":35971.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02345923","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.85,"discounted_cash":317.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith","code_information":[{"code":"02345927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":56222.4,"discounted_cash":28111.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Atherectomy","code_information":[{"code":"02345932","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":17670.5,"discounted_cash":8835.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Gia","code_information":[{"code":"02345934","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.73,"discounted_cash":392.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extractor Surgical","code_information":[{"code":"02345942","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1142.19,"discounted_cash":571.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Simplex","code_information":[{"code":"02345947","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02345949","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":18260.5,"discounted_cash":9130.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02345951","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15379.2,"discounted_cash":7689.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Fiducial Superlock","code_information":[{"code":"02345953_106772","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.01,"discounted_cash":562.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Marker Fiducial Superlock","code_information":[{"code":"02345953","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.01,"discounted_cash":562.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Slider","code_information":[{"code":"02345961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2101.6,"discounted_cash":1050.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02345962_71461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.8,"discounted_cash":752.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02345962_9124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.8,"discounted_cash":752.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02345962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1504.8,"discounted_cash":752.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Slider","code_information":[{"code":"02345964","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2124.69,"discounted_cash":1062.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft","code_information":[{"code":"02345967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealer Bi-Polar","code_information":[{"code":"02345968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5759.6,"discounted_cash":2879.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glidecath","code_information":[{"code":"02345985","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":417.46,"discounted_cash":208.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cv Cath Dual Luman","code_information":[{"code":"02345991","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1149.96,"discounted_cash":574.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Slider","code_information":[{"code":"02345995","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2101.6,"discounted_cash":1050.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Extension Cables","code_information":[{"code":"02345999_84904","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lead Extension Cables","code_information":[{"code":"02345999","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stone Extractor","code_information":[{"code":"02346014","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1388.46,"discounted_cash":694.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Viabil Biliary","code_information":[{"code":"02346016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":13440.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ph Probe Adult","code_information":[{"code":"02346017","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":800.68,"discounted_cash":400.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoablation Probe","code_information":[{"code":"02346023","type":"CDM"},{"code":"272","type":"RC"},{"code":"C9808","type":"HCPCS"}],"standard_charges":[{"gross_charge":15040.0,"discounted_cash":7520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trace Pointer","code_information":[{"code":"02346033","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4093.6,"discounted_cash":2046.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recorder System Cardiac Reveal Linq Insertable Monitor","code_information":[{"code":"02346034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":24190.0,"discounted_cash":12095.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spectra Pulse Generator Kit","code_information":[{"code":"02346040_114037","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":91500.0,"discounted_cash":45750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Spectra Pulse Generator Kit","code_information":[{"code":"02346040_115533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":91500.0,"discounted_cash":45750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Spectra Pulse Generator Kit","code_information":[{"code":"02346040_124795","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":91500.0,"discounted_cash":45750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Spectra Pulse Generator Kit","code_information":[{"code":"02346040","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":91500.0,"discounted_cash":45750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ph Probe Adult Without Impedence","code_information":[{"code":"02346043","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":517.32,"discounted_cash":258.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manoshield Endoscopy","code_information":[{"code":"02346044","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":445.1,"discounted_cash":222.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Balloon","code_information":[{"code":"02346046","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Coronary Graftmaster","code_information":[{"code":"02346047","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Putty","code_information":[{"code":"02346050_127660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9408.0,"discounted_cash":4704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Putty","code_information":[{"code":"02346050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9408.0,"discounted_cash":4704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Direx Medium Curve Sheath","code_information":[{"code":"02346053","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5623.6,"discounted_cash":2811.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Davinci Stapler Reloads","code_information":[{"code":"02346062","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1327.68,"discounted_cash":663.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Overtube Enterospcope","code_information":[{"code":"02346068_85417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":795.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Overtube Enterospcope","code_information":[{"code":"02346068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1591.0,"discounted_cash":795.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Net Retrieval Roth","code_information":[{"code":"02346069_85418","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Net Retrieval Roth","code_information":[{"code":"02346069","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stone Basket","code_information":[{"code":"02346070","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1768.6,"discounted_cash":884.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoscopic Clip","code_information":[{"code":"02346071","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3396.6,"discounted_cash":1698.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoscopic Clip","code_information":[{"code":"02346072","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3964.4,"discounted_cash":1982.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Otsc Grasper","code_information":[{"code":"02346073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4515.2,"discounted_cash":2257.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finger Trap","code_information":[{"code":"02346079","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1043.4,"discounted_cash":521.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Dual Chamber","code_information":[{"code":"02346093","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":23570.5,"discounted_cash":11785.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02346095","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":18850.5,"discounted_cash":9425.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Biventricular","code_information":[{"code":"02346098","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":33264.0,"discounted_cash":16632.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp Endo Babcock","code_information":[{"code":"02346101_85598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":491.91,"discounted_cash":245.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Clamp Endo Babcock","code_information":[{"code":"02346101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.05,"discounted_cash":255.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Pad 1 Pc Cpr","code_information":[{"code":"02347000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1037.18,"discounted_cash":518.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste","code_information":[{"code":"02347008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Modular Head Sleeve","code_information":[{"code":"02347010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1388.61,"discounted_cash":694.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02347011","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":59672.7,"discounted_cash":29836.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Low Flow Vapotherm","code_information":[{"code":"02347015","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":941.28,"discounted_cash":470.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02347020","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter","code_information":[{"code":"02347022","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3842.0,"discounted_cash":1921.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Angiassist Delivery System","code_information":[{"code":"02347024","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":745.75,"discounted_cash":372.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Annuloplasty","code_information":[{"code":"02347026","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Venous Cannula","code_information":[{"code":"02347027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2904.06,"discounted_cash":1452.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Bilayer Wound Matrix 2X2","code_information":[{"code":"02347039","type":"CDM"},{"code":"278","type":"RC"},{"code":"C9363","type":"HCPCS"}],"standard_charges":[{"gross_charge":19848.31,"discounted_cash":9924.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Chait Percutaneous","code_information":[{"code":"02347044","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1568.8,"discounted_cash":784.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Portal Pivot Kit","code_information":[{"code":"02347049","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2561.81,"discounted_cash":1280.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Transcath Sapien W/Deliv System","code_information":[{"code":"02347054","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":162500.0,"discounted_cash":81250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02347060","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.38,"discounted_cash":294.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Hydroset 10Cc","code_information":[{"code":"02347068","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":23924.5,"discounted_cash":11962.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Strata Ii","code_information":[{"code":"02347070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":34442.07,"discounted_cash":17221.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Slingshot Closer Device","code_information":[{"code":"02347078","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2091.91,"discounted_cash":1045.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Eus Slimline","code_information":[{"code":"02347094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3253.5,"discounted_cash":1626.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Eus Slimline","code_information":[{"code":"02347095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1555.98,"discounted_cash":777.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Eus Slimline","code_information":[{"code":"02347096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1420.73,"discounted_cash":710.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Finishing Burr","code_information":[{"code":"02347109_116791","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Finishing Burr","code_information":[{"code":"02347109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trufreeze Sray Kit","code_information":[{"code":"02347111","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12768.0,"discounted_cash":6384.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Platinum Chromium Rebel Rx","code_information":[{"code":"02347124","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02347126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1468.53,"discounted_cash":734.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthrowand Ambient","code_information":[{"code":"02347129","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1676.84,"discounted_cash":838.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Infusion","code_information":[{"code":"02347131","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":6475.58,"discounted_cash":3237.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Zoll Kit Start Up","code_information":[{"code":"02347132","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.74,"discounted_cash":740.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Target Nano","code_information":[{"code":"02347134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13600.0,"discounted_cash":6800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02347137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":12901.76,"discounted_cash":6450.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprosthesis Viabahn","code_information":[{"code":"02347139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":39838.4,"discounted_cash":19919.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trivantage Emg Tube","code_information":[{"code":"02347145_86865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2480.92,"discounted_cash":1240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Trivantage Emg Tube","code_information":[{"code":"02347145_86866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2480.92,"discounted_cash":1240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Trivantage Emg Tube","code_information":[{"code":"02347145","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2480.92,"discounted_cash":1240.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Rotating Tightrail","code_information":[{"code":"02347153","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14624.0,"discounted_cash":7312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Rotating Tightrail Mini","code_information":[{"code":"02347154","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11488.0,"discounted_cash":5744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent W Delivery System","code_information":[{"code":"02347158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":1289.23,"discounted_cash":644.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Over Stitch Edndoscopic Suturing","code_information":[{"code":"02347164","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8160.0,"discounted_cash":4080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Apollo  Endo Suture","code_information":[{"code":"02347165","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":507.63,"discounted_cash":253.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Quickclip Pro Length","code_information":[{"code":"02347169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1327.4,"discounted_cash":663.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Tenckhoff 6 Cm 62 Cm","code_information":[{"code":"02347173","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.6,"discounted_cash":643.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Steerable Agilis","code_information":[{"code":"02347176","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Breathing Viasys","code_information":[{"code":"02347178","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":906.48,"discounted_cash":453.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02347179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon  Lutonix","code_information":[{"code":"02347180","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":11520.0,"discounted_cash":5760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bronchoscope Flexible","code_information":[{"code":"02347181","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1909.2,"discounted_cash":954.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Micro","code_information":[{"code":"02347184","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3808.0,"discounted_cash":1904.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Connector","code_information":[{"code":"02347186","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1117.4,"discounted_cash":558.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Tenckhof","code_information":[{"code":"02347187","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":1184.0,"discounted_cash":592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Tenckhoff Peritoneoscopic","code_information":[{"code":"02347188","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1435.6,"discounted_cash":717.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Needle Kit","code_information":[{"code":"02347192","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Needle Kit","code_information":[{"code":"02347193","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":832.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trocar","code_information":[{"code":"02347198_3582957","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.33,"discounted_cash":291.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trocar","code_information":[{"code":"02347198_68203","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":570.13,"discounted_cash":285.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Trocar","code_information":[{"code":"02347198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.33,"discounted_cash":291.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Monocanalicular Stent","code_information":[{"code":"02347199","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":969.4,"discounted_cash":484.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Nasal Sinus","code_information":[{"code":"02347203_87338","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1704.86,"discounted_cash":852.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Dressing Nasal Sinus","code_information":[{"code":"02347203_88452","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1330.48,"discounted_cash":665.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Dressing Nasal Sinus","code_information":[{"code":"02347203","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1704.86,"discounted_cash":852.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Endo","code_information":[{"code":"02347205","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2772.19,"discounted_cash":1386.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Endo","code_information":[{"code":"02347206_106702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3391.27,"discounted_cash":1695.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stapler Endo","code_information":[{"code":"02347206","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3391.27,"discounted_cash":1695.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Knife","code_information":[{"code":"02347207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1546.6,"discounted_cash":773.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste","code_information":[{"code":"02347209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15930.0,"discounted_cash":7965.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02347212","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":7456.0,"discounted_cash":3728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Atherectomy","code_information":[{"code":"02347213","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":15900.5,"discounted_cash":7950.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Irrigation Catheter","code_information":[{"code":"02347216","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":2804.6,"discounted_cash":1402.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead, Aicd, Endo Single Coil","code_information":[{"code":"02347218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Intraspinal","code_information":[{"code":"02347220","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Connector","code_information":[{"code":"02347222","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2654.91,"discounted_cash":1327.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02347225","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1655.34,"discounted_cash":827.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_22070","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_22355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_24032","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_24033","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_24034","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_24038","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227_80504","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Head","code_information":[{"code":"02347227","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2003.1,"discounted_cash":1001.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02347231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02347233","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.97,"discounted_cash":999.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02347234_72008","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":611.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nail","code_information":[{"code":"02347234_77533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":611.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02347234","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1223.0,"discounted_cash":611.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Round Fluted","code_information":[{"code":"02347237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1135.9,"discounted_cash":567.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02347244","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":441.48,"discounted_cash":220.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Neurostim Test Kit","code_information":[{"code":"02347257","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02347258","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.21,"discounted_cash":504.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02347261","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2183.0,"discounted_cash":1091.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02347262_122596","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16000.0,"discounted_cash":8000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02347262","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16000.0,"discounted_cash":8000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ttp-Variac  System","code_information":[{"code":"02347263","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3433.6,"discounted_cash":1716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02347265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cuff Urethral Inhibizone","code_information":[{"code":"02347277","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":43134.0,"discounted_cash":21567.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor","code_information":[{"code":"02347278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3712.8,"discounted_cash":1856.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Spacer","code_information":[{"code":"02347281","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1679.8,"discounted_cash":839.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02347282_87475","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Burr","code_information":[{"code":"02347282_87476","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Burr","code_information":[{"code":"02347282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02347283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1836.83,"discounted_cash":918.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Versitomic G-Lock","code_information":[{"code":"02347287","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1052.5,"discounted_cash":526.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Dilation","code_information":[{"code":"02347291_30327","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.9,"discounted_cash":713.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Dilation","code_information":[{"code":"02347291_30328","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.9,"discounted_cash":713.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Dilation","code_information":[{"code":"02347291","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":1427.9,"discounted_cash":713.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Zilver","code_information":[{"code":"02347300","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":7520.0,"discounted_cash":3760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Zilver","code_information":[{"code":"02347301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9568.0,"discounted_cash":4784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Zilver","code_information":[{"code":"02347302","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":11488.0,"discounted_cash":5744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Zilver","code_information":[{"code":"02347303","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antena Emprint","code_information":[{"code":"02347305","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":18809.2,"discounted_cash":9404.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation Thermacool","code_information":[{"code":"02347308","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":18502.4,"discounted_cash":9251.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02347320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16744.55,"discounted_cash":8372.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Countersink For Screws","code_information":[{"code":"02347325","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3354.42,"discounted_cash":1677.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue","code_information":[{"code":"02347336","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":9843.58,"discounted_cash":4921.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02347337","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1793.76,"discounted_cash":896.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve  Control Copilot","code_information":[{"code":"02347350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":643.7,"discounted_cash":321.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cruciate Accessory Kit","code_information":[{"code":"02347351","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2080.88,"discounted_cash":1040.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laser Fiber Flexiva 500","code_information":[{"code":"02347357_129116","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2857.14,"discounted_cash":1428.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Laser Fiber Flexiva 500","code_information":[{"code":"02347357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2857.14,"discounted_cash":1428.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02347360","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.06,"discounted_cash":504.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Tray Ped Single Lumen Ven","code_information":[{"code":"02347367","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":594.56,"discounted_cash":297.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Stent Bifurcated","code_information":[{"code":"02347380","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":50274.0,"discounted_cash":25137.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Afx","code_information":[{"code":"02347381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3485.4,"discounted_cash":1742.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vela Suprarenal","code_information":[{"code":"02347382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30794.4,"discounted_cash":15397.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Limb Extension","code_information":[{"code":"02347384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22296.1,"discounted_cash":11148.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extractor Pro Xl Ercp","code_information":[{"code":"02347385","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":754.58,"discounted_cash":377.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Long Handle","code_information":[{"code":"02347406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17670.5,"discounted_cash":8835.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe  Pathfinder","code_information":[{"code":"02347408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knfe Type Od","code_information":[{"code":"02347439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3559.4,"discounted_cash":1779.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Spyscope","code_information":[{"code":"02347448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15680.0,"discounted_cash":7840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Ultra Express","code_information":[{"code":"02347451_88454","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":12089.6,"discounted_cash":6044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Balloon Ultra Express","code_information":[{"code":"02347451","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":12089.6,"discounted_cash":6044.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_100358","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.33,"discounted_cash":340.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_100360","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.4,"discounted_cash":329.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_100361","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":654.17,"discounted_cash":327.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_100363","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_102973","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_73745","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454_73762","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02347454","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Neurostimulator","code_information":[{"code":"02347467","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":48692.0,"discounted_cash":24346.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Maryland Lap Device","code_information":[{"code":"02347468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3673.21,"discounted_cash":1836.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Biopsy Kit","code_information":[{"code":"02347469","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3672.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Biopsy Kit","code_information":[{"code":"02347470","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2934.84,"discounted_cash":1467.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Percussion Vest","code_information":[{"code":"02347477","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":592.2,"discounted_cash":296.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Pancreatic","code_information":[{"code":"02347481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.98,"discounted_cash":349.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Delivery System","code_information":[{"code":"02347483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":646.6,"discounted_cash":323.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02347493","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.21,"discounted_cash":504.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules","code_information":[{"code":"02347496","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6069.0,"discounted_cash":3034.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules","code_information":[{"code":"02347496_126439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6069.0,"discounted_cash":3034.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bridle Nasal","code_information":[{"code":"02347499","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":783.43,"discounted_cash":391.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Premicron Needle","code_information":[{"code":"02347507","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":398.66,"discounted_cash":199.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ecmo Circuit","code_information":[{"code":"02347511","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":1350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Markers Visicoil","code_information":[{"code":"02347512","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.4,"discounted_cash":762.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02347514","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":75097.03,"discounted_cash":37548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02347522","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Billary","code_information":[{"code":"02347524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02347526","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":10662.4,"discounted_cash":5331.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C Collar Occian","code_information":[{"code":"02347531","type":"CDM"},{"code":"271","type":"RC"}],"standard_charges":[{"gross_charge":786.32,"discounted_cash":393.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ocochlear Implant","code_information":[{"code":"02347533","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":81794.3,"discounted_cash":40897.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Processor Cochlear Implant","code_information":[{"code":"02347534","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":55664.0,"discounted_cash":27832.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter","code_information":[{"code":"02347536","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7084.8,"discounted_cash":3542.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc End Cap Star Altitude","code_information":[{"code":"02347552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3702.6,"discounted_cash":1851.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Mpa","code_information":[{"code":"02347553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Vascular Access Ecmo","code_information":[{"code":"02347564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1158.84,"discounted_cash":579.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare Captivator Device","code_information":[{"code":"02347572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2275.8,"discounted_cash":1137.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilation","code_information":[{"code":"02347575","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7488.0,"discounted_cash":3744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Barrx Balloon 360","code_information":[{"code":"02347580","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15009.6,"discounted_cash":7504.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pump Blood Centrimag","code_information":[{"code":"02347586","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":66780.0,"discounted_cash":33390.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Margin Marker 6C","code_information":[{"code":"02347591","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1290.71,"discounted_cash":645.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forcep Ureteropie","code_information":[{"code":"02347595","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2277.94,"discounted_cash":1138.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02347608","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3381.43,"discounted_cash":1690.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Artificial Fixation","code_information":[{"code":"02347612","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4828.0,"discounted_cash":2414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Smart Ablate Tubing","code_information":[{"code":"02347623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":737.9,"discounted_cash":368.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste","code_information":[{"code":"02347624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6426.0,"discounted_cash":3213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tray Catheter Triple Lumen Dialysis","code_information":[{"code":"02347628","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1661.15,"discounted_cash":830.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cuff Urethral Inhibizone","code_information":[{"code":"02347638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1815","type":"HCPCS"}],"standard_charges":[{"gross_charge":41059.2,"discounted_cash":20529.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02347639","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":97000.0,"discounted_cash":48500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Defib Non Sing/Dual","code_information":[{"code":"02347640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1896","type":"HCPCS"}],"standard_charges":[{"gross_charge":25753.5,"discounted_cash":12876.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Cannula","code_information":[{"code":"02347642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":682.49,"discounted_cash":341.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps Grasping","code_information":[{"code":"02347647_89517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":547.93,"discounted_cash":273.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Forceps Grasping","code_information":[{"code":"02347647","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":547.93,"discounted_cash":273.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Nasogastric","code_information":[{"code":"02347649","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2244.49,"discounted_cash":1122.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dtrax Spinal System","code_information":[{"code":"02347653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8480.0,"discounted_cash":4240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cor Knot Suture System","code_information":[{"code":"02347666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5202.0,"discounted_cash":2601.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Cutting Guide","code_information":[{"code":"02347667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Stent Sinus Propel","code_information":[{"code":"02347669_89641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6886.4,"discounted_cash":3443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc  Stent Sinus Propel","code_information":[{"code":"02347669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6886.4,"discounted_cash":3443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation Bidirectional","code_information":[{"code":"02347678","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":10560.0,"discounted_cash":5280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Decapolar Catheter","code_information":[{"code":"02347680","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Decapolar Catheter","code_information":[{"code":"02347681","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":1369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tubing Ablation","code_information":[{"code":"02347683_119968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tubing Ablation","code_information":[{"code":"02347683","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02347684","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":12000.0,"discounted_cash":6000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ensite Navx Patch Kit","code_information":[{"code":"02347685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiomem Delivery System","code_information":[{"code":"02347686","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2624","type":"HCPCS"}],"standard_charges":[{"gross_charge":117500.0,"discounted_cash":58750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endograft Vela Suprarenal","code_information":[{"code":"02347688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30156.0,"discounted_cash":15078.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Amniopro","code_information":[{"code":"02347689","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":23570.5,"discounted_cash":11785.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraosseous Needle Set Peds","code_information":[{"code":"02347698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1055.24,"discounted_cash":527.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraosseous Needle Set Adult","code_information":[{"code":"02347699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1138.12,"discounted_cash":569.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Splinting Tubing","code_information":[{"code":"02347701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1926.0,"discounted_cash":963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prodigy Programmer","code_information":[{"code":"02347704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10720.0,"discounted_cash":5360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr Highspeed","code_information":[{"code":"02347724","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon  Lutonix","code_information":[{"code":"02347725","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":9728.0,"discounted_cash":4864.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Admiral","code_information":[{"code":"02347726","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":7488.0,"discounted_cash":3744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Implant","code_information":[{"code":"02347727","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15847.4,"discounted_cash":7923.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amt Dilator Kit","code_information":[{"code":"02347728","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02347733_129025","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4104.28,"discounted_cash":2052.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Reamer","code_information":[{"code":"02347733","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4104.28,"discounted_cash":2052.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02347744_128598","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5725.6,"discounted_cash":2862.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Toe Implant","code_information":[{"code":"02347744","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6651.52,"discounted_cash":3325.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chips Cancellous","code_information":[{"code":"02347750","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3648.2,"discounted_cash":1824.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chips Cancellous","code_information":[{"code":"02347750_129331","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3648.2,"discounted_cash":1824.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02347753","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":17670.5,"discounted_cash":8835.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Implant Custom","code_information":[{"code":"02347759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":59089.01,"discounted_cash":29544.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute Putty","code_information":[{"code":"02347761","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9024.0,"discounted_cash":4512.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endopaddle","code_information":[{"code":"02347765","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":783.44,"discounted_cash":391.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Colonic Wallstent","code_information":[{"code":"02347772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":14972.55,"discounted_cash":7486.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02347776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4753.06,"discounted_cash":2376.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Kyphoplasty","code_information":[{"code":"02347782_92928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20650.0,"discounted_cash":10325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Kyphoplasty","code_information":[{"code":"02347782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20650.0,"discounted_cash":10325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Mixere Pack","code_information":[{"code":"02347783_90268","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.8,"discounted_cash":969.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cement Mixere Pack","code_information":[{"code":"02347783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1938.8,"discounted_cash":969.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dissection Balloon","code_information":[{"code":"02347784","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3411.7,"discounted_cash":1705.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bb-Tak","code_information":[{"code":"02347788","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Myosure Tissue Removal System","code_information":[{"code":"02347793","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.7,"discounted_cash":2222.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Ivus","code_information":[{"code":"02347797","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":5984.0,"discounted_cash":2992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Internal Brace Implant System","code_information":[{"code":"02347799_98204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7212.8,"discounted_cash":3606.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Internal Brace Implant System","code_information":[{"code":"02347799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6880.0,"discounted_cash":3440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Prosthesis","code_information":[{"code":"02347802","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":69218.69,"discounted_cash":34609.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suction Electrode Dome Vapr Arctic","code_information":[{"code":"02347804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4549.2,"discounted_cash":2274.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inzii Retrieval System","code_information":[{"code":"02347811","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vessel Sealer","code_information":[{"code":"02347821","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4046.0,"discounted_cash":2023.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg Drill","code_information":[{"code":"02347838","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.15,"discounted_cash":388.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Diagnostic 5/6 Fr","code_information":[{"code":"02347840","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3207.9,"discounted_cash":1603.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Airway Exchange","code_information":[{"code":"02347853","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":619.37,"discounted_cash":309.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Fastfix","code_information":[{"code":"02347856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3429.9,"discounted_cash":1714.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02347858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4930.0,"discounted_cash":2465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vapr Arctic Chisel Electrode","code_information":[{"code":"02347866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4549.2,"discounted_cash":2274.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Endovascular Zenith","code_information":[{"code":"02347870","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":91567.0,"discounted_cash":45783.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02347872","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":20294.82,"discounted_cash":10147.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Lead Sacromodulation Tined","code_information":[{"code":"02347878_111230","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":19912.5,"discounted_cash":9956.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Lead Sacromodulation Tined","code_information":[{"code":"02347878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":19912.5,"discounted_cash":9956.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dermis Decellularized 2.5 X 3.5","code_information":[{"code":"02347879","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":22431.8,"discounted_cash":11215.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Packing Sinus Nasopore","code_information":[{"code":"02347887","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":958.44,"discounted_cash":479.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Capsure Perm Fixation","code_information":[{"code":"02347897","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Dialysis","code_information":[{"code":"02347904","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1752","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.05,"discounted_cash":641.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Tracker","code_information":[{"code":"02347905","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1412.73,"discounted_cash":706.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anmniograft","code_information":[{"code":"02347907","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":21240.0,"discounted_cash":10620.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Innova","code_information":[{"code":"02347909","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4590.0,"discounted_cash":2295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Innova","code_information":[{"code":"02347910","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Innova","code_information":[{"code":"02347911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":17670.5,"discounted_cash":8835.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Synergy Everolimus-Eluting","code_information":[{"code":"02347912_113972","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent Synergy Everolimus-Eluting","code_information":[{"code":"02347912","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Procinch Adjus Loop Impt Stand Tens","code_information":[{"code":"02347913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture","code_information":[{"code":"02347915","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":508.68,"discounted_cash":254.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle 5/6.5 Inch","code_information":[{"code":"02347916_89486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle 5/6.5 Inch","code_information":[{"code":"02347916","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement","code_information":[{"code":"02347917","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9280.0,"discounted_cash":4640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cement Bone","code_information":[{"code":"02347924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Removal Myosure","code_information":[{"code":"02347927_99677","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":8000.0,"discounted_cash":4000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tissue Removal Myosure","code_information":[{"code":"02347927","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":8000.0,"discounted_cash":4000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microcatheter Velocity Delivery","code_information":[{"code":"02347934","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6630.4,"discounted_cash":3315.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02347935","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3589.0,"discounted_cash":1794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath","code_information":[{"code":"02347939","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":873.13,"discounted_cash":436.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Implant Reservior","code_information":[{"code":"02347941","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":14777.6,"discounted_cash":7388.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Dual Chamber","code_information":[{"code":"02347944","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":20060.0,"discounted_cash":10030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Feeding Jejunal","code_information":[{"code":"02347949","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1128.94,"discounted_cash":564.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex","code_information":[{"code":"02347957","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":13968.16,"discounted_cash":6984.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Dilatation Peripheral","code_information":[{"code":"02347961","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Jamshidi","code_information":[{"code":"02347962_87241","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1376.4,"discounted_cash":688.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Jamshidi","code_information":[{"code":"02347962","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1376.4,"discounted_cash":688.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chips Cancellous","code_information":[{"code":"02347978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2597.4,"discounted_cash":1298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Chondrofix","code_information":[{"code":"02347988","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":8555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02347998","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":11915.52,"discounted_cash":5957.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Pipeline Embolic Device","code_information":[{"code":"02348000","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":77342.9,"discounted_cash":38671.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Pipeline Embolic Device","code_information":[{"code":"02348001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":83395.0,"discounted_cash":41697.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02348004","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15841.5,"discounted_cash":7920.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trach Tube","code_information":[{"code":"02348008","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":496.43,"discounted_cash":248.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Vapr","code_information":[{"code":"02348013","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1228.4,"discounted_cash":614.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tyrx Absorbable Defib Env","code_information":[{"code":"02348021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02348026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":678.24,"discounted_cash":339.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passer Transosseous","code_information":[{"code":"02348034_3603720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passer Transosseous","code_information":[{"code":"02348034_91848","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer Transosseous","code_information":[{"code":"02348034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Envelope Tyrx Neuro Absorb Antibiotic","code_information":[{"code":"02348036","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Feeding Cortrack 2","code_information":[{"code":"02348041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.76,"discounted_cash":238.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Eus Preloaded","code_information":[{"code":"02348042","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":3604.0,"discounted_cash":1802.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trimano Arm Kit","code_information":[{"code":"02348045_91956","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Trimano Arm Kit","code_information":[{"code":"02348045","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Casting Boot Tcc-Ez Lg/Xl","code_information":[{"code":"02348046_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":645.27,"discounted_cash":322.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Casting Boot Tcc-Ez Lg/Xl","code_information":[{"code":"02348046","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":645.27,"discounted_cash":322.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Laser Turbo","code_information":[{"code":"02348055","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":22390.5,"discounted_cash":11195.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hipec Ht 2000 Kit","code_information":[{"code":"02348062","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22125.0,"discounted_cash":11062.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02348067","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":36400.0,"discounted_cash":18200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Breathing Airvo","code_information":[{"code":"02348068","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":448.42,"discounted_cash":224.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Breathing Airvo","code_information":[{"code":"02348068_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":448.42,"discounted_cash":224.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02348076","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":9408.0,"discounted_cash":4704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reload Endowrist","code_information":[{"code":"02348077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1327.68,"discounted_cash":663.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02348095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":15628.8,"discounted_cash":7814.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Line Femoral Maximum Barrier","code_information":[{"code":"02348097","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":935.36,"discounted_cash":467.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Delineator Advinvula","code_information":[{"code":"02348115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":996.21,"discounted_cash":498.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Specify Surescan Lead","code_information":[{"code":"02348125","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":54852.0,"discounted_cash":27426.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Liver Biopsy Set","code_information":[{"code":"02348128","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Stabilization Chair","code_information":[{"code":"02348136_3610699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.73,"discounted_cash":270.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Stabilization Chair","code_information":[{"code":"02348136_92486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.73,"discounted_cash":270.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Stabilization Chair","code_information":[{"code":"02348136","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.73,"discounted_cash":270.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Resolution 360","code_information":[{"code":"02348145_107124","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1324.6,"discounted_cash":662.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Clip Resolution 360","code_information":[{"code":"02348145","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1324.6,"discounted_cash":662.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Minerva Ablation System","code_information":[{"code":"02348151_92588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Minerva Ablation System","code_information":[{"code":"02348151","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Curved Epimed","code_information":[{"code":"02348154_127323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Curved Epimed","code_information":[{"code":"02348154","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrosurgical Microdebrider","code_information":[{"code":"02348160","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3596.4,"discounted_cash":1798.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bridge Occlusion Balloon","code_information":[{"code":"02348168","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6154.0,"discounted_cash":3077.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occlusion Balloon Kit Prep","code_information":[{"code":"02348169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1054.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Prosthesis","code_information":[{"code":"02348170","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":29428.0,"discounted_cash":14714.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Fnb Aquire","code_information":[{"code":"02348180","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3010.69,"discounted_cash":1505.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Smartswitch","code_information":[{"code":"02348186","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1302.4,"discounted_cash":651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Dual Chamber","code_information":[{"code":"02348190","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":20237.0,"discounted_cash":10118.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinplus 6 X 16 Mm","code_information":[{"code":"02348194","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":12480.0,"discounted_cash":6240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Anchor X Clik","code_information":[{"code":"02348197_92962","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.2,"discounted_cash":1250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lead Anchor X Clik","code_information":[{"code":"02348197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2501.2,"discounted_cash":1250.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passer","code_information":[{"code":"02348198_125296","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1371.96,"discounted_cash":685.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Passer","code_information":[{"code":"02348198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1371.96,"discounted_cash":685.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02348199","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":63070.0,"discounted_cash":31535.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02348201","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":62328.0,"discounted_cash":31164.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348207","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":8320.0,"discounted_cash":4160.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348208","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":11200.0,"discounted_cash":5600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348209","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":16225.0,"discounted_cash":8112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wire Indigo","code_information":[{"code":"02348211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6912.0,"discounted_cash":3456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Indigo Clot Collection Canister","code_information":[{"code":"02348214","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":1350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Supera","code_information":[{"code":"02348217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":10880.0,"discounted_cash":5440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Xbraid","code_information":[{"code":"02348226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":886.74,"discounted_cash":443.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Neuron","code_information":[{"code":"02348228","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Rd Burr","code_information":[{"code":"02348229","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1135.9,"discounted_cash":567.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Harvestor","code_information":[{"code":"02348230_68797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3418.8,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Reamer Harvestor","code_information":[{"code":"02348230","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3418.8,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Harvestor","code_information":[{"code":"02348230_74622","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3418.8,"discounted_cash":1709.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Stent Bifurcated","code_information":[{"code":"02348235","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":71544.7,"discounted_cash":35772.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Spu W/ Neb","code_information":[{"code":"02348238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Kit Customizable","code_information":[{"code":"02348259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3978.0,"discounted_cash":1989.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Button Nasal Septal","code_information":[{"code":"02348265","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02348267","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":91800.0,"discounted_cash":45900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02348268","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":58432.5,"discounted_cash":29216.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit Infinion","code_information":[{"code":"02348270_93517","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lead Kit Infinion","code_information":[{"code":"02348270","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Or Spectra","code_information":[{"code":"02348271_93518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cable Or Spectra","code_information":[{"code":"02348271","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02348282","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":2915.6,"discounted_cash":1457.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02348289","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":9280.0,"discounted_cash":4640.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microsphere Embolization","code_information":[{"code":"02348290","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Valvuloplasty","code_information":[{"code":"02348292","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7520.0,"discounted_cash":3760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Achilles Speedbridge Implant","code_information":[{"code":"02348295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":3315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extration Kit Alexis","code_information":[{"code":"02348297","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stem Distal Radioulnar","code_information":[{"code":"02348299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15847.4,"discounted_cash":7923.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abdominal Tray Monitor","code_information":[{"code":"02348303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":740.29,"discounted_cash":370.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neosys Set","code_information":[{"code":"02348305","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5922.8,"discounted_cash":2961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endovascular","code_information":[{"code":"02348307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28526.5,"discounted_cash":14263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuro Shunt Certas","code_information":[{"code":"02348313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29792.0,"discounted_cash":14896.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Harvesting Canister","code_information":[{"code":"02348316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3746.8,"discounted_cash":1873.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocool Probe","code_information":[{"code":"02348319","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1886","type":"HCPCS"}],"standard_charges":[{"gross_charge":26113.11,"discounted_cash":13056.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Transseptal","code_information":[{"code":"02348330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3492.8,"discounted_cash":1746.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Processor Cochlear Implant","code_information":[{"code":"02348332","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":53748.04,"discounted_cash":26874.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Loading","code_information":[{"code":"02348336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Graft","code_information":[{"code":"02348349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":35980.56,"discounted_cash":17990.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cochlear Implant System","code_information":[{"code":"02348352","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":87397.0,"discounted_cash":43698.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Device Fixate","code_information":[{"code":"02348354_94424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Device Fixate","code_information":[{"code":"02348354","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02348356_114038","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02348356","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tunneling Tool","code_information":[{"code":"02348357_94427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tunneling Tool","code_information":[{"code":"02348357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trocar Unishunt","code_information":[{"code":"02348358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2455.02,"discounted_cash":1227.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_124763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.62,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_124766","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.62,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_124767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.48,"discounted_cash":209.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_125948","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":400.58,"discounted_cash":200.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_129721","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.62,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.62,"discounted_cash":197.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Biopsy","code_information":[{"code":"02348362_94464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.48,"discounted_cash":209.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pulmonary Apc Probe","code_information":[{"code":"02348370","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1742.7,"discounted_cash":871.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Screwdriver","code_information":[{"code":"02348378","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2671.4,"discounted_cash":1335.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02348381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":39937.25,"discounted_cash":19968.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02348383","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":82500.0,"discounted_cash":41250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gelpoint Ptap","code_information":[{"code":"02348384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5610.0,"discounted_cash":2805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Watchman Laa Closure Device","code_information":[{"code":"02348391","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":85000.0,"discounted_cash":42500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Access Sys Watchman","code_information":[{"code":"02348392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Cellentra 1 Cc","code_information":[{"code":"02348402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3337.4,"discounted_cash":1668.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02348406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2301.4,"discounted_cash":1150.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Cruise Serfas Ablator","code_information":[{"code":"02348412_93262","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1252.89,"discounted_cash":626.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Cruise Serfas Ablator","code_information":[{"code":"02348412","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1252.89,"discounted_cash":626.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348437","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02348440","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":93150.0,"discounted_cash":46575.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Bone Intergro","code_information":[{"code":"02348442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.2,"discounted_cash":1269.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02348443","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":68688.0,"discounted_cash":34344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Coronary Venous","code_information":[{"code":"02348448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1900","type":"HCPCS"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02348449","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":75097.03,"discounted_cash":37548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Neurostimulator Vns","code_information":[{"code":"02348451","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":47843.32,"discounted_cash":23921.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare","code_information":[{"code":"02348453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2449.4,"discounted_cash":1224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pancreatic Stent","code_information":[{"code":"02348454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":26738.8,"discounted_cash":13369.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Trinity Elite","code_information":[{"code":"02348460","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3415.4,"discounted_cash":1707.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sharpshooter Handle","code_information":[{"code":"02348466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Sharpshooter","code_information":[{"code":"02348467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Feeding Transgastric","code_information":[{"code":"02348468","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3780.8,"discounted_cash":1890.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02348470","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":5766.4,"discounted_cash":2883.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Angiographic Soft-Vu","code_information":[{"code":"02348474","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.3,"discounted_cash":384.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Burr","code_information":[{"code":"02348488","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":984.87,"discounted_cash":492.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Magnifuse 2.5 X 10 Cm","code_information":[{"code":"02348497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29399.7,"discounted_cash":14699.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary","code_information":[{"code":"02348501","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":8479.74,"discounted_cash":4239.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retrieval System","code_information":[{"code":"02348507","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02348509","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":61178.11,"discounted_cash":30589.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tray Infusaport Clearvue","code_information":[{"code":"02348524_128320","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tray Infusaport Clearvue","code_information":[{"code":"02348524_95271","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tray Infusaport Clearvue","code_information":[{"code":"02348524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1788","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Core Biopsy Instrument Disposable","code_information":[{"code":"02348526_124762","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Core Biopsy Instrument Disposable","code_information":[{"code":"02348526_124767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Core Biopsy Instrument Disposable","code_information":[{"code":"02348526_95275","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Core Biopsy Instrument Disposable","code_information":[{"code":"02348526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tubing Outflow Cassette","code_information":[{"code":"02348527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":440.39,"discounted_cash":220.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ureterscope Digital Flex Lithovue","code_information":[{"code":"02348528","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02348536","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":56975.0,"discounted_cash":28487.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graftjacket 4Cm X 7Cm","code_information":[{"code":"02348538","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"gross_charge":14092.8,"discounted_cash":7046.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Decapolar Catheter","code_information":[{"code":"02348539","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":4930.0,"discounted_cash":2465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Wedge","code_information":[{"code":"02348559","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":20650.0,"discounted_cash":10325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passer","code_information":[{"code":"02348560","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Cutting Guide","code_information":[{"code":"02348564","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":16826.56,"discounted_cash":8413.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Power Stapler","code_information":[{"code":"02348566","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.89,"discounted_cash":387.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Restrictor Cement","code_information":[{"code":"02348569","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Pump","code_information":[{"code":"02348571","type":"CDM"},{"code":"272","type":"RC"},{"code":"C9804","type":"HCPCS"}],"standard_charges":[{"gross_charge":910.2,"discounted_cash":455.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Hemodialysis","code_information":[{"code":"02348572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1750","type":"HCPCS"}],"standard_charges":[{"gross_charge":2597.4,"discounted_cash":1298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Atherectomy","code_information":[{"code":"02348580","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1714","type":"HCPCS"}],"standard_charges":[{"gross_charge":18260.5,"discounted_cash":9130.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02348583","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":5984.0,"discounted_cash":2992.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocool Access Kit","code_information":[{"code":"02348587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3167.2,"discounted_cash":1583.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocool Delievery System","code_information":[{"code":"02348588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3115.4,"discounted_cash":1557.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dermis Decellularized  30 X 40Mm","code_information":[{"code":"02348589_116210","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":7515.43,"discounted_cash":3757.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Dermis Decellularized  30 X 40Mm","code_information":[{"code":"02348589_127657","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":7462.4,"discounted_cash":3731.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Dermis Decellularized  30 X 40Mm","code_information":[{"code":"02348589","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":7462.4,"discounted_cash":3731.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocool Biopsy Device","code_information":[{"code":"02348590","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocool Cement","code_information":[{"code":"02348591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":620.15,"discounted_cash":310.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit  Kit Hfjv","code_information":[{"code":"02348606","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2294.0,"discounted_cash":1147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules 5Cc","code_information":[{"code":"02348615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6744.24,"discounted_cash":3372.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules 10Cc","code_information":[{"code":"02348616","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11530.43,"discounted_cash":5765.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02348621","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":5950.0,"discounted_cash":2975.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02348624","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":91800.0,"discounted_cash":45900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Marker/Clip Tumark Vision Breast","code_information":[{"code":"02348633_103252","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biopsy Marker/Clip Tumark Vision Breast","code_information":[{"code":"02348633_123037","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biopsy Marker/Clip Tumark Vision Breast","code_information":[{"code":"02348633","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.6,"discounted_cash":298.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor Alexis","code_information":[{"code":"02348634","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Post External Fixation","code_information":[{"code":"02348642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1870.79,"discounted_cash":935.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Versaflex","code_information":[{"code":"02348655","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":891.7,"discounted_cash":445.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Rotating Tightrail","code_information":[{"code":"02348656","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11488.0,"discounted_cash":5744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Leg Endoprost","code_information":[{"code":"02348662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":61230.9,"discounted_cash":30615.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprost Bifurcated","code_information":[{"code":"02348663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28526.5,"discounted_cash":14263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Alblation","code_information":[{"code":"02348667","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":26113.11,"discounted_cash":13056.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoanchor Aptus","code_information":[{"code":"02348669","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10143.36,"discounted_cash":5071.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endoanchor Applier","code_information":[{"code":"02348670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":25222.5,"discounted_cash":12611.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02348672","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02348676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Top Virage","code_information":[{"code":"02348691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Nitinol","code_information":[{"code":"02348708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Epifix 2 X 3","code_information":[{"code":"02348717","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":6895.1,"discounted_cash":3447.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Epifix 4 X 4.5","code_information":[{"code":"02348718","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":8741.12,"discounted_cash":4370.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trocar Airseal","code_information":[{"code":"02348720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3747.48,"discounted_cash":1873.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02348723","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3108.0,"discounted_cash":1554.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02348727","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":17700.0,"discounted_cash":8850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Shaft","code_information":[{"code":"02348750","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3115.4,"discounted_cash":1557.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02348762","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":1363.82,"discounted_cash":681.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348767","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6494.0,"discounted_cash":3247.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Barium Silicone Bactiseal Set","code_information":[{"code":"02348769","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6471.17,"discounted_cash":3235.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Taper Point Circle Chord X","code_information":[{"code":"02348770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipofilter Cannister","code_information":[{"code":"02348786","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1617.57,"discounted_cash":808.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh","code_information":[{"code":"02348790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":37497.6,"discounted_cash":18748.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Uphold Mesh","code_information":[{"code":"02348808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":15074.5,"discounted_cash":7537.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Fiberwire","code_information":[{"code":"02348811","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":494.55,"discounted_cash":247.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex Hd","code_information":[{"code":"02348814","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":52415.5,"discounted_cash":26207.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abdominal Stent Graft","code_information":[{"code":"02348816","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":63594.7,"discounted_cash":31797.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Abdominal Stent Graft","code_information":[{"code":"02348817","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29199.1,"discounted_cash":14599.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Custom Seal","code_information":[{"code":"02348819","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6426.0,"discounted_cash":3213.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02348821","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":3369.96,"discounted_cash":1684.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Biventricular","code_information":[{"code":"02348823","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":34720.0,"discounted_cash":17360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Canulla Probe","code_information":[{"code":"02348827_97953","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Canulla Probe","code_information":[{"code":"02348827","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lapcinch Grasper","code_information":[{"code":"02348831_98115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.05,"discounted_cash":255.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lapcinch Grasper","code_information":[{"code":"02348831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.05,"discounted_cash":255.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Halo Vest Open Back","code_information":[{"code":"02348837","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0810","type":"HCPCS"}],"standard_charges":[{"gross_charge":12480.0,"discounted_cash":6240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Abdominal Iliac","code_information":[{"code":"02348847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28722.4,"discounted_cash":14361.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Aortic Ovation","code_information":[{"code":"02348850","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":66244.7,"discounted_cash":33122.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02348857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Skin","code_information":[{"code":"02348858","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02348863","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":15296.0,"discounted_cash":7648.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Detacher Coil Deployment","code_information":[{"code":"02348867","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.45,"discounted_cash":223.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Curved","code_information":[{"code":"02348880","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retriever Roth Net","code_information":[{"code":"02348887_98777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Retriever Roth Net","code_information":[{"code":"02348887","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps Moray Micro","code_information":[{"code":"02348888","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Resection 14Mm X 27Mm","code_information":[{"code":"02348890","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02348893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Ablation","code_information":[{"code":"02348897","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1733","type":"HCPCS"}],"standard_charges":[{"gross_charge":25665.0,"discounted_cash":12832.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coaxial Umbilical","code_information":[{"code":"02348899","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrical Umbilical","code_information":[{"code":"02348900","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1554.0,"discounted_cash":777.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Steerable Flexcath","code_information":[{"code":"02348901","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Achieve Connector","code_information":[{"code":"02348902","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":832.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bicep Distal Repair Implant","code_information":[{"code":"02348906_98959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bicep Distal Repair Implant","code_information":[{"code":"02348906","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02348907","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":28025.0,"discounted_cash":14012.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fludizer Positioner Pillow Z4","code_information":[{"code":"02348911","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":484.27,"discounted_cash":242.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Plug Apical","code_information":[{"code":"02348927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Neurovascular Coiling Axs","code_information":[{"code":"02348933","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1885","type":"HCPCS"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Concerto Coil Fibered","code_information":[{"code":"02348934","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc External Neurostimulator Boot","code_information":[{"code":"02348937","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":714.35,"discounted_cash":357.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Flex Hd","code_information":[{"code":"02348944","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":21809.94,"discounted_cash":10904.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Pupil Expander","code_information":[{"code":"02348945_99337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1017.5,"discounted_cash":508.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ring Pupil Expander","code_information":[{"code":"02348945","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1017.5,"discounted_cash":508.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Subcondroplasty 5Cc 11 Ga","code_information":[{"code":"02348948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18261.09,"discounted_cash":9130.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Internal Brace Implant System","code_information":[{"code":"02348957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9568.0,"discounted_cash":4784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02348959","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Med Vac Veraflow","code_information":[{"code":"02348964","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6912.0,"discounted_cash":3456.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Implant Custom","code_information":[{"code":"02348965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":56000.0,"discounted_cash":28000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ipg Template","code_information":[{"code":"02348969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.4,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Anchor","code_information":[{"code":"02348970","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1398.6,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vaporflex Probe Bipolar","code_information":[{"code":"02348973","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3672.0,"discounted_cash":1836.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Versicon Tubing","code_information":[{"code":"02348975","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02348981","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5751.37,"discounted_cash":2875.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02348982","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6326.58,"discounted_cash":3163.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02348984","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7925.57,"discounted_cash":3962.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Fenestrated With Trocar","code_information":[{"code":"02348990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1813.0,"discounted_cash":906.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kii Low Profile Optical Sleeve And Obturator","code_information":[{"code":"02348993","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":499.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Disposable","code_information":[{"code":"02348997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.15,"discounted_cash":388.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Radiofrequency","code_information":[{"code":"02349001","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1888","type":"HCPCS"}],"standard_charges":[{"gross_charge":3071.0,"discounted_cash":1535.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349002","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1665.0,"discounted_cash":832.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349026_117010","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.31,"discounted_cash":197.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349026_95625","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.31,"discounted_cash":197.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349026","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.31,"discounted_cash":197.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349027","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349028","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.28,"discounted_cash":238.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349029","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.09,"discounted_cash":262.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349030_129388","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349030_48814","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349030_87690","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349030","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349031","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349032_3603819","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349032_96622","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349032_96625","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349032","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349033_53108","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349033","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349033_65293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349034_129394","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349034","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349035_104986","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349035","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349036_42811","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349036_53020","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349036","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349037","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349038","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1168.16,"discounted_cash":584.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349039","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349040","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349041","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1555.11,"discounted_cash":777.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349042","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1710.66,"discounted_cash":855.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349043","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349044","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349046","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":2504.97,"discounted_cash":1252.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349048","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3031.19,"discounted_cash":1515.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349049","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3334.37,"discounted_cash":1667.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349050","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349051","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":3707.56,"discounted_cash":1853.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349052","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4078.44,"discounted_cash":2039.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349053_110903","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.3,"discounted_cash":2243.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Guidewire","code_information":[{"code":"02349053","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4486.3,"discounted_cash":2243.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349054","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":4935.03,"discounted_cash":2467.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guidewire","code_information":[{"code":"02349057","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1769","type":"HCPCS"}],"standard_charges":[{"gross_charge":6568.73,"discounted_cash":3284.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349092","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":433.87,"discounted_cash":216.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349093","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.28,"discounted_cash":238.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349094","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":525.09,"discounted_cash":262.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349095_53316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc K-Wire","code_information":[{"code":"02349095","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":577.68,"discounted_cash":288.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349096_11320","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc K-Wire","code_information":[{"code":"02349096","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":635.54,"discounted_cash":317.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349097","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":699.2,"discounted_cash":349.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349098","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":769.14,"discounted_cash":384.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349099_100136","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc K-Wire","code_information":[{"code":"02349099","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":797.65,"discounted_cash":398.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349100_89350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc K-Wire","code_information":[{"code":"02349100","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":877.49,"discounted_cash":438.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":965.33,"discounted_cash":482.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349102","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1061.9,"discounted_cash":530.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349104","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1285.08,"discounted_cash":642.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349105","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1413.7,"discounted_cash":706.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349108","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1881.82,"discounted_cash":940.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349109","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2070.08,"discounted_cash":1035.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349111","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2504.97,"discounted_cash":1252.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc K-Wire","code_information":[{"code":"02349115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3667.88,"discounted_cash":1833.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilation","code_information":[{"code":"02349120","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":9408.0,"discounted_cash":4704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgical Skin Closure","code_information":[{"code":"02349127","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02349128","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9388.8,"discounted_cash":4694.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Mapping Achieve","code_information":[{"code":"02349129","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Onestep Resusitation Pads","code_information":[{"code":"02349133","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":539.69,"discounted_cash":269.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02349134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4131.0,"discounted_cash":2065.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules 15Cc","code_information":[{"code":"02349138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15615.49,"discounted_cash":7807.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiber Slim Line","code_information":[{"code":"02349142","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3608.09,"discounted_cash":1804.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349143","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02349145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11424.0,"discounted_cash":5712.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules 20 Cc Osteoamp","code_information":[{"code":"02349152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":17007.34,"discounted_cash":8503.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prclaim Elite 5 Nerve Stimulator","code_information":[{"code":"02349154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":115000.0,"discounted_cash":57500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Apollo","code_information":[{"code":"02349161","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tray Spinal Epidural","code_information":[{"code":"02349167_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.04,"discounted_cash":238.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tray Spinal Epidural","code_information":[{"code":"02349167","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.06,"discounted_cash":238.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Frame Fixator","code_information":[{"code":"02349169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5079.6,"discounted_cash":2539.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Custom","code_information":[{"code":"02349179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14606.85,"discounted_cash":7303.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02349183","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":20275.35,"discounted_cash":10137.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Splint Nasal Denver","code_information":[{"code":"02349187_100018","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":553.43,"discounted_cash":276.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Splint Nasal Denver","code_information":[{"code":"02349187","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":553.43,"discounted_cash":276.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Dual Chamber","code_information":[{"code":"02349191","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1785","type":"HCPCS"}],"standard_charges":[{"gross_charge":23428.9,"discounted_cash":11714.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eustachian Tube Balloon","code_information":[{"code":"02349193","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":10728.58,"discounted_cash":5364.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sentiva Neurostimulator","code_information":[{"code":"02349194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":169475.0,"discounted_cash":84737.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Impella Pump Set","code_information":[{"code":"02349198","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125000.0,"discounted_cash":62500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pad Pt Transfer Air Pal Disposable","code_information":[{"code":"02349213","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":537.73,"discounted_cash":268.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02349229","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":42000.0,"discounted_cash":21000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Onyx Cobalt Stent","code_information":[{"code":"02349231","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg","code_information":[{"code":"02349236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.2,"discounted_cash":282.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rod","code_information":[{"code":"02349238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1309.8,"discounted_cash":654.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Marker Gold 18G 20Cm 3 Needles Pack","code_information":[{"code":"02349240","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Marker Gold 18G 20Cm 1 Needle","code_information":[{"code":"02349241","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1963.52,"discounted_cash":981.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Marker Gold Couples 2 Needles Pack","code_information":[{"code":"02349242","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":610.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Alloaid","code_information":[{"code":"02349244","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11936.0,"discounted_cash":5968.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Non Chg 4-6 Fr","code_information":[{"code":"02349246_C1751_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2032.56,"discounted_cash":1016.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Picc Non Chg 4-6 Fr","code_information":[{"code":"02349246","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2136.13,"discounted_cash":1068.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scissor Tip Eversharp Disposable","code_information":[{"code":"02349248","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":432.38,"discounted_cash":216.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuroform Stent","code_information":[{"code":"02349254","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37878.4,"discounted_cash":18939.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Midline Single Lumen W Chloragard Tray 4.5 Fr Lf","code_information":[{"code":"02349255","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1336.44,"discounted_cash":668.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adult Compression Vest","code_information":[{"code":"02349259","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":477.67,"discounted_cash":238.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Inserter Tip","code_information":[{"code":"02349260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":779.22,"discounted_cash":389.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meniscal Implant Kit","code_information":[{"code":"02349266","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6520.72,"discounted_cash":3260.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02349267_100938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02349267_121044","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02349267","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Eyelid Implant","code_information":[{"code":"02349271","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Taper Adaptor","code_information":[{"code":"02349272","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Augmented Reamer","code_information":[{"code":"02349273","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":643.7,"discounted_cash":321.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare Spyglass","code_information":[{"code":"02349277","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3554.9,"discounted_cash":1777.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neurostimulator External Eval","code_information":[{"code":"02349278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2439.04,"discounted_cash":1219.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Mapping","code_information":[{"code":"02349288","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":14720.0,"discounted_cash":7360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gore Iliac","code_information":[{"code":"02349295","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":61951.7,"discounted_cash":30975.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gore Internal Iliac","code_information":[{"code":"02349296","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":20065.9,"discounted_cash":10032.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gore Contralateral Leg Excluder","code_information":[{"code":"02349297","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":28526.5,"discounted_cash":14263.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Photon Blade","code_information":[{"code":"02349302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1054.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lighted Sigmoidoscope  Disp","code_information":[{"code":"02349303_101430","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lighted Sigmoidoscope  Disp","code_information":[{"code":"02349303","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Kit 50Cm","code_information":[{"code":"02349307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02349308_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":897.36,"discounted_cash":448.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Endo Shears","code_information":[{"code":"02349309","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":469.74,"discounted_cash":234.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insertion Sleeve","code_information":[{"code":"02349310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1062.34,"discounted_cash":531.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biomark Mammotome","code_information":[{"code":"02349311_101709","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.7,"discounted_cash":298.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biomark Mammotome","code_information":[{"code":"02349311_128686","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.68,"discounted_cash":298.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biomark Mammotome","code_information":[{"code":"02349311_A4648_278","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.68,"discounted_cash":298.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biomark Mammotome","code_information":[{"code":"02349311","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.71,"discounted_cash":298.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Esaphogeal Temp","code_information":[{"code":"02349312","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8448.0,"discounted_cash":4224.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vessel Sealer Endowrist Da Vinci Xi","code_information":[{"code":"02349316_101757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4463.07,"discounted_cash":2231.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Vessel Sealer Endowrist Da Vinci Xi","code_information":[{"code":"02349316_112271","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4463.07,"discounted_cash":2231.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Vessel Sealer Endowrist Da Vinci Xi","code_information":[{"code":"02349316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4463.07,"discounted_cash":2231.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Periview Flex","code_information":[{"code":"02349319","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2066.45,"discounted_cash":1033.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulse Generator Kit Implantable","code_information":[{"code":"02349322_111229","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":86500.0,"discounted_cash":43250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pulse Generator Kit Implantable","code_information":[{"code":"02349322","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1767","type":"HCPCS"}],"standard_charges":[{"gross_charge":86500.0,"discounted_cash":43250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Phasix","code_information":[{"code":"02349324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":29999.2,"discounted_cash":14999.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Flexible Side Deploy Applicator","code_information":[{"code":"02349331","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.09,"discounted_cash":543.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Replacment","code_information":[{"code":"02349332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":497.26,"discounted_cash":248.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02349336","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.43,"discounted_cash":468.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Talus Implant","code_information":[{"code":"02349339","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":82500.0,"discounted_cash":41250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Extension","code_information":[{"code":"02349340_123859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":610.34,"discounted_cash":305.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Extension","code_information":[{"code":"02349340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":610.34,"discounted_cash":305.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ensizor Flexible Endoscopic","code_information":[{"code":"02349342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2380.33,"discounted_cash":1190.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02349345","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":6528.0,"discounted_cash":3264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mr Visicoil Pgla Spacer","code_information":[{"code":"02349348","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":2072.0,"discounted_cash":1036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349349","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6011.2,"discounted_cash":3005.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Portal Skid","code_information":[{"code":"02349350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02349352_97849","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.86,"discounted_cash":220.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02349352","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":440.86,"discounted_cash":220.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microcatheter System Progreat","code_information":[{"code":"02349357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3808.0,"discounted_cash":1904.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microcatheter Progreat","code_information":[{"code":"02349358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2442.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Hemostasis","code_information":[{"code":"02349361_102365","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.25,"discounted_cash":255.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Valve Hemostasis","code_information":[{"code":"02349361","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":525.56,"discounted_cash":262.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Strut Short Rapid","code_information":[{"code":"02349364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9293.44,"discounted_cash":4646.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Passwer","code_information":[{"code":"02349374","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Intra-Cardiac Echo","code_information":[{"code":"02349376","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1759","type":"HCPCS"}],"standard_charges":[{"gross_charge":13440.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biofoam Cotton Wedge","code_information":[{"code":"02349384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6623.2,"discounted_cash":3311.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02349385","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":24160.5,"discounted_cash":12080.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spiration Kit","code_information":[{"code":"02349397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spiration Valve 9Mm","code_information":[{"code":"02349398","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":20355.0,"discounted_cash":10177.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spiration Valve","code_information":[{"code":"02349399","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15635.0,"discounted_cash":7817.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoanalgesia Smart Tip Iovera","code_information":[{"code":"02349400","type":"CDM"},{"code":"272","type":"RC"},{"code":"C9809","type":"HCPCS"}],"standard_charges":[{"gross_charge":4076.6,"discounted_cash":2038.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Nasal Tip Endoflip","code_information":[{"code":"02349407","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2997.0,"discounted_cash":1498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath Dryseal Flex","code_information":[{"code":"02349408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5834.4,"discounted_cash":2917.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ear Implant Hires Ultra 3D","code_information":[{"code":"02349412","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":97397.0,"discounted_cash":48698.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02349415","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":68900.0,"discounted_cash":34450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg Locking","code_information":[{"code":"02349416","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.8,"discounted_cash":377.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bra Compression","code_information":[{"code":"02349421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":634.28,"discounted_cash":317.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bronchoscope Flexible","code_information":[{"code":"02349422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2212.6,"discounted_cash":1106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tortoise Positionerr","code_information":[{"code":"02349424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1471.86,"discounted_cash":735.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Revolve Stereotactic","code_information":[{"code":"02349430","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8116.29,"discounted_cash":4058.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02349434","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":10876.8,"discounted_cash":5438.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Echelon Flex","code_information":[{"code":"02349437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9127.81,"discounted_cash":4563.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vac Veraflo Cleanse Choice Dressing Large","code_information":[{"code":"02349442","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1918.08,"discounted_cash":959.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bos Drill Battery Pack","code_information":[{"code":"02349447","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":851.0,"discounted_cash":425.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Ancetabular","code_information":[{"code":"02349450","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11232.0,"discounted_cash":5616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02349454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.6,"discounted_cash":495.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02349455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.82,"discounted_cash":545.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Head","code_information":[{"code":"02349456","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1199.94,"discounted_cash":599.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Sleeve","code_information":[{"code":"02349459","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1062.34,"discounted_cash":531.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02349461","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2424.46,"discounted_cash":1212.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nasal Latera Implant","code_information":[{"code":"02349482_103557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nasal Latera Implant","code_information":[{"code":"02349482","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent W Delivery System","code_information":[{"code":"02349483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.71,"discounted_cash":477.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Epidural Needle","code_information":[{"code":"02349493","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":556.17,"discounted_cash":278.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheeth Dilator","code_information":[{"code":"02349494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":980.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Molding And Occlusion","code_information":[{"code":"02349497","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3576.8,"discounted_cash":1788.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Expressbraid","code_information":[{"code":"02349500_125359","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":418.33,"discounted_cash":209.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suture Expressbraid","code_information":[{"code":"02349500","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.45,"discounted_cash":223.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor With Trocar","code_information":[{"code":"02349501_103968","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1768.6,"discounted_cash":884.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Retractor With Trocar","code_information":[{"code":"02349501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Biventricular","code_information":[{"code":"02349507","type":"CDM"},{"code":"275","type":"RC"},{"code":"C2621","type":"HCPCS"}],"standard_charges":[{"gross_charge":34580.0,"discounted_cash":17290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vena Cava Filter","code_information":[{"code":"02349510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1880","type":"HCPCS"}],"standard_charges":[{"gross_charge":10720.0,"discounted_cash":5360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw Set","code_information":[{"code":"02349512","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":902.8,"discounted_cash":451.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Biopsy Site","code_information":[{"code":"02349519_96178","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Marker Biopsy Site","code_information":[{"code":"02349519","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sacrocolpopexy Tip","code_information":[{"code":"02349520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.15,"discounted_cash":388.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Implant","code_information":[{"code":"02349523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":75578.0,"discounted_cash":37789.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349525","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349527","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vascular Plug","code_information":[{"code":"02349529","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6228.8,"discounted_cash":3114.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knife Bayonotted","code_information":[{"code":"02349532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3542.8,"discounted_cash":1771.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vac Veraflo Cleanse Choice Dressing  Medium","code_information":[{"code":"02349537","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1021.2,"discounted_cash":510.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Esophageal","code_information":[{"code":"02349539","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15360.0,"discounted_cash":7680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Knife","code_information":[{"code":"02349544","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1546.6,"discounted_cash":773.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02349546","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.99,"discounted_cash":466.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02349548","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":948.75,"discounted_cash":474.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Innova","code_information":[{"code":"02349551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4732.8,"discounted_cash":2366.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349552","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":5028.6,"discounted_cash":2514.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Angiographic","code_information":[{"code":"02349553","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1136.05,"discounted_cash":568.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349554","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6528.0,"discounted_cash":3264.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sensor Finger Cuff","code_information":[{"code":"02349555","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2516.0,"discounted_cash":1258.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349556","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":8288.0,"discounted_cash":4144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ifuse Bone Implant System","code_information":[{"code":"02349560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":19765.0,"discounted_cash":9882.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Infuse","code_information":[{"code":"02349561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22449.5,"discounted_cash":11224.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Instrument Kit Alloaid","code_information":[{"code":"02349562","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5922.8,"discounted_cash":2961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Pancreatic","code_information":[{"code":"02349563","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":28811.16,"discounted_cash":14405.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Putty","code_information":[{"code":"02349568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7302.4,"discounted_cash":3651.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02349569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Stem","code_information":[{"code":"02349570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2138.13,"discounted_cash":1069.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Template Kit","code_information":[{"code":"02349572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11488.0,"discounted_cash":5744.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02349577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":23511.5,"discounted_cash":11755.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Catheter Intrathecal","code_information":[{"code":"02349579","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Spacer","code_information":[{"code":"02349581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Quickclot","code_information":[{"code":"02349587","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1967.77,"discounted_cash":983.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Quickclot","code_information":[{"code":"02349588","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1089.84,"discounted_cash":544.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Spacer","code_information":[{"code":"02349589","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.4,"discounted_cash":447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprosthesis Viabahn","code_information":[{"code":"02349591","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":8555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sponge Acticoat Exfix Dressing","code_information":[{"code":"02349599","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":534.11,"discounted_cash":267.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Tray Bone","code_information":[{"code":"02349606_104044","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":3598.87,"discounted_cash":1799.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Biopsy Tray Bone","code_information":[{"code":"02349606","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":3598.87,"discounted_cash":1799.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Tibialis","code_information":[{"code":"02349608_115107","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15148.25,"discounted_cash":7574.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Tibialis","code_information":[{"code":"02349608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15148.25,"discounted_cash":7574.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Full Body Girdle","code_information":[{"code":"02349613","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02349618","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3174.82,"discounted_cash":1587.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pain Programmer","code_information":[{"code":"02349623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9772.8,"discounted_cash":4886.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Kit Axiem","code_information":[{"code":"02349624","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3821.6,"discounted_cash":1910.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mitraclip","code_information":[{"code":"02349637","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":150000.0,"discounted_cash":75000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypothermia Chest Wrap Gaymar","code_information":[{"code":"02349642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":436.46,"discounted_cash":218.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Am 1.6Cm Disc Collagen Matrix","code_information":[{"code":"02349643","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement","code_information":[{"code":"02349645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02349652","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":1090.76,"discounted_cash":545.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pad Pt Transfer Air Pal Disp 50 X 78In","code_information":[{"code":"02349653","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":744.69,"discounted_cash":372.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biopsy Clip/Marker","code_information":[{"code":"02349654","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":614.91,"discounted_cash":307.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penumbra Canister Sys","code_information":[{"code":"02349659","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2664.0,"discounted_cash":1332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plate Fitting Temporary","code_information":[{"code":"02349661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2624.78,"discounted_cash":1312.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Cryoablation","code_information":[{"code":"02349667","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":13408.0,"discounted_cash":6704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vns Accessory Kit","code_information":[{"code":"02349671","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5206.76,"discounted_cash":2603.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation Thermocool Smart Touch","code_information":[{"code":"02349682","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":21092.5,"discounted_cash":10546.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation Thermocool Smart Touch","code_information":[{"code":"02349683","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":22166.3,"discounted_cash":11083.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Diagnostic Decanav","code_information":[{"code":"02349688","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":7648.0,"discounted_cash":3824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Speedband Ligator","code_information":[{"code":"02349690","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1067.49,"discounted_cash":533.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Am 2X2Cm Collagen Matrix","code_information":[{"code":"02349691","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Am 6X9Cm Collagen Matrix","code_information":[{"code":"02349692","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":28728.0,"discounted_cash":14364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laa Exclusion Clip","code_information":[{"code":"02349697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11840.0,"discounted_cash":5920.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Synergy Access Isolator","code_information":[{"code":"02349698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":8555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Colonic","code_information":[{"code":"02349699","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8672.0,"discounted_cash":4336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Granules","code_information":[{"code":"02349705","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4148.0,"discounted_cash":2074.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laser Probe","code_information":[{"code":"02349707","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1858.66,"discounted_cash":929.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Silkon Oil","code_information":[{"code":"02349711","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3110.52,"discounted_cash":1555.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349713","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":3589.0,"discounted_cash":1794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Access Watchman","code_information":[{"code":"02349714","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snap Cartridge Wound Care 125Mmhg","code_information":[{"code":"02349720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1025.64,"discounted_cash":512.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligator Universal","code_information":[{"code":"02349722","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2094.2,"discounted_cash":1047.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Bionest","code_information":[{"code":"02349737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Bionest","code_information":[{"code":"02349738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Am 5 X 5 Cm Collagen Matrix","code_information":[{"code":"02349740","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":15340.0,"discounted_cash":7670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cutting Guide","code_information":[{"code":"02349745","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9888.0,"discounted_cash":4944.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Kit Restor","code_information":[{"code":"02349764","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprosthesis Bifurcatedexcluder","code_information":[{"code":"02349765","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":20065.9,"discounted_cash":10032.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Memebrane Sensor Kit Radiometer","code_information":[{"code":"02349769","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":727.37,"discounted_cash":363.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Forceps Endoomyocardial","code_information":[{"code":"02349771","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1058.2,"discounted_cash":529.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02349774","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":2725.12,"discounted_cash":1362.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Posterior Chamber","code_information":[{"code":"02349776","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tap Cannulated","code_information":[{"code":"02349777_129395","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4263.6,"discounted_cash":2131.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tap Cannulated","code_information":[{"code":"02349777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4263.6,"discounted_cash":2131.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Plasma Coagulation Applicator","code_information":[{"code":"02349781","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1379.36,"discounted_cash":689.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meniscal Repair Device","code_information":[{"code":"02349782","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":573.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meniscal Repair Device","code_information":[{"code":"02349783","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Nushield 1.6Cm Disc Tissue","code_information":[{"code":"02349789","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":1461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Tissue Nushield 2X4Cm","code_information":[{"code":"02349791","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibertape Cerclage Suture","code_information":[{"code":"02349797_106997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fibertape Cerclage Suture","code_information":[{"code":"02349797","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3330.0,"discounted_cash":1665.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pad Protector","code_information":[{"code":"02349801_107110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":469.43,"discounted_cash":234.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pad Protector","code_information":[{"code":"02349801","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":469.43,"discounted_cash":234.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluidics Mngt Centurion","code_information":[{"code":"02349806","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3940.26,"discounted_cash":1970.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dynanite Staple","code_information":[{"code":"02349808","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12128.0,"discounted_cash":6064.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Buzz Hole Cover","code_information":[{"code":"02349809","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1702.0,"discounted_cash":851.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ascenda Intrathecal Catheter","code_information":[{"code":"02349811","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1755","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Tissue Visicoal Fiducial","code_information":[{"code":"02349820","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":1450.4,"discounted_cash":725.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead, Aicd, Endo Single Coil","code_information":[{"code":"02349822","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":17346.0,"discounted_cash":8673.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Angel Tray Prp","code_information":[{"code":"02349824_107364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Angel Tray Prp","code_information":[{"code":"02349824","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2405.0,"discounted_cash":1202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc 3Fr Single Arrow","code_information":[{"code":"02349825","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.52,"discounted_cash":387.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349827","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02349836_130025","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12048.26,"discounted_cash":6024.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Screw","code_information":[{"code":"02349836","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12048.26,"discounted_cash":6024.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Flexhd Pliable Pre Lg/Xl","code_information":[{"code":"02349840","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":70046.18,"discounted_cash":35023.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Flexhd Pliable Pre Medium","code_information":[{"code":"02349841","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":64660.0,"discounted_cash":32330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Flexhd Pliable Pre Small","code_information":[{"code":"02349842","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":56286.0,"discounted_cash":28143.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Protector Hydrogel","code_information":[{"code":"02349846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16000.0,"discounted_cash":8000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349849","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9324.8,"discounted_cash":4662.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Intravscular Us Opticross","code_information":[{"code":"02349850","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Centurion Ultravit","code_information":[{"code":"02349856_107188","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1612.28,"discounted_cash":806.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Centurion Ultravit","code_information":[{"code":"02349856","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1674.4,"discounted_cash":837.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02349857","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":2237.76,"discounted_cash":1118.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auto Injector Abdominal Stent Graft","code_information":[{"code":"02349860","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3322.6,"discounted_cash":1661.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypothermia Large Set Of 4 Pads Artic Sun","code_information":[{"code":"02349861","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7529.31,"discounted_cash":3764.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349862_3581846","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349862_75799","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349863","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349864","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":1517.0,"discounted_cash":758.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula","code_information":[{"code":"02349865","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1252.75,"discounted_cash":626.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02349875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6732.0,"discounted_cash":3366.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Detachment Handle","code_information":[{"code":"02349877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1761.2,"discounted_cash":880.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349879","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Substitute Injectable","code_information":[{"code":"02349884","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7552.0,"discounted_cash":3776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tube Feeding","code_information":[{"code":"02349885","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":533.8,"discounted_cash":266.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Pacemaker Othr Than Trans","code_information":[{"code":"02349892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1898","type":"HCPCS"}],"standard_charges":[{"gross_charge":3145.0,"discounted_cash":1572.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Extension Set With Luer Lock","code_information":[{"code":"02349893_104501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":468.88,"discounted_cash":234.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Extension Set With Luer Lock","code_information":[{"code":"02349893","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":468.88,"discounted_cash":234.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Halo Vest Open Back Large","code_information":[{"code":"02349896","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0810","type":"HCPCS"}],"standard_charges":[{"gross_charge":12480.0,"discounted_cash":6240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349897","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":4012.0,"discounted_cash":2006.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Ebus","code_information":[{"code":"02349898","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1410.07,"discounted_cash":705.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilatation","code_information":[{"code":"02349900","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":12172.8,"discounted_cash":6086.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accessory Kit","code_information":[{"code":"02349904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02349906","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":1909.2,"discounted_cash":954.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Zenith Spiral Iliac","code_information":[{"code":"02349913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":27435.0,"discounted_cash":13717.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02349915","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":16815.0,"discounted_cash":8407.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02349920","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":6840.0,"discounted_cash":3420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02349921","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Drainage","code_information":[{"code":"02349924","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1729","type":"HCPCS"}],"standard_charges":[{"gross_charge":2017.24,"discounted_cash":1008.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intraosseous Bioplasty","code_information":[{"code":"02349926_105877","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Intraosseous Bioplasty","code_information":[{"code":"02349926","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amniotic Membrane","code_information":[{"code":"02349927","type":"CDM"},{"code":"278","type":"RC"},{"code":"V2790","type":"HCPCS"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02349928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":416.29,"discounted_cash":208.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Cryoblation","code_information":[{"code":"02349931","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":11200.0,"discounted_cash":5600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Electrophisiology","code_information":[{"code":"02349934","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02349938","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15310.5,"discounted_cash":7655.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thermo Ablation","code_information":[{"code":"02349941","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3597.2,"discounted_cash":1798.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02349949","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":16266.3,"discounted_cash":8133.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Biliary","code_information":[{"code":"02349952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device Vascular","code_information":[{"code":"02349957","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1760","type":"HCPCS"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surgisis Graft","code_information":[{"code":"02349959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":13075.2,"discounted_cash":6537.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Crew Antirotation","code_information":[{"code":"02349960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2227.77,"discounted_cash":1113.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Illuminated Flex Curved","code_information":[{"code":"02349964","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1731.08,"discounted_cash":865.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device 25+ Finesse Flex Loop Dsp","code_information":[{"code":"02349967","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1063.31,"discounted_cash":531.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Vitrectomy Constellation Ultravit","code_information":[{"code":"02349972","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2374.81,"discounted_cash":1187.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Serfas Sweep Xl","code_information":[{"code":"02349974_108118","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3322.6,"discounted_cash":1661.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Serfas Sweep Xl","code_information":[{"code":"02349974","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3322.6,"discounted_cash":1661.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shim Posterior","code_information":[{"code":"02349979","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2952.6,"discounted_cash":1476.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Single Chamber","code_information":[{"code":"02349983","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1722","type":"HCPCS"}],"standard_charges":[{"gross_charge":60155.0,"discounted_cash":30077.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Egr Endo Kit","code_information":[{"code":"02349988","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5924.84,"discounted_cash":2962.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lateral Access System","code_information":[{"code":"02349990","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3712.8,"discounted_cash":1856.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Augment Inj 3.0 Cc","code_information":[{"code":"02349993","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1734","type":"HCPCS"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Augment Inj 1.5 Cc","code_information":[{"code":"02349994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1734","type":"HCPCS"}],"standard_charges":[{"gross_charge":10880.0,"discounted_cash":5440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Ablation","code_information":[{"code":"02350005","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15900.5,"discounted_cash":7950.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Trunode Gamma","code_information":[{"code":"02350011","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2219.26,"discounted_cash":1109.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350012","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":13440.0,"discounted_cash":6720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Internal Brace Implant System","code_information":[{"code":"02350015","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9568.0,"discounted_cash":4784.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Prep Kit","code_information":[{"code":"02350021","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1398.6,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Grasper Raptor","code_information":[{"code":"02350029","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pacemaker Single Chamber","code_information":[{"code":"02350030","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1786","type":"HCPCS"}],"standard_charges":[{"gross_charge":70225.0,"discounted_cash":35112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer Flexor","code_information":[{"code":"02350032_129424","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":988.05,"discounted_cash":494.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Sheath Introducer Flexor","code_information":[{"code":"02350032","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":988.05,"discounted_cash":494.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Bicoag Hemostasis","code_information":[{"code":"02350034_111276","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1154.4,"discounted_cash":577.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Probe Bicoag Hemostasis","code_information":[{"code":"02350034","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1154.4,"discounted_cash":577.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Soft Tissue Release System","code_information":[{"code":"02350041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6711.6,"discounted_cash":3355.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vascular Coil","code_information":[{"code":"02350052","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3620.45,"discounted_cash":1810.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mandible Trumatch Midface Guide","code_information":[{"code":"02350056","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":16943.03,"discounted_cash":8471.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gel Ent Prolaryn","code_information":[{"code":"02350064_109399","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8607","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Gel Ent Prolaryn","code_information":[{"code":"02350064","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8607","type":"HCPCS"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Localizer Applicator Set","code_information":[{"code":"02350090","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":3726.4,"discounted_cash":1863.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bravo Reflux Capsule & Delivery System","code_information":[{"code":"02350099_108463","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2274.76,"discounted_cash":1137.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bravo Reflux Capsule & Delivery System","code_information":[{"code":"02350099_3601358","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2274.76,"discounted_cash":1137.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bravo Reflux Capsule & Delivery System","code_information":[{"code":"02350099","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2274.76,"discounted_cash":1137.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Htc Lens","code_information":[{"code":"02350113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":466.77,"discounted_cash":233.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02350117_110319","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":5732.4,"discounted_cash":2866.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patient Programmer Neurostimulator","code_information":[{"code":"02350117","type":"CDM"},{"code":"270","type":"RC"},{"code":"C1787","type":"HCPCS"}],"standard_charges":[{"gross_charge":5732.4,"discounted_cash":2866.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neurostimulator Axonics","code_information":[{"code":"02350118","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":56890.2,"discounted_cash":28445.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Axonics Charger","code_information":[{"code":"02350119","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6120.0,"discounted_cash":3060.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Mini Monoka","code_information":[{"code":"02350123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Harvesting Kit","code_information":[{"code":"02350126","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":23322.7,"discounted_cash":11661.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02350129","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defibrillator, Dual Chamber","code_information":[{"code":"02350130","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1721","type":"HCPCS"}],"standard_charges":[{"gross_charge":66250.0,"discounted_cash":33125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Nasal Stent","code_information":[{"code":"02350132_110561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Implant Nasal Stent","code_information":[{"code":"02350132","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15328.0,"discounted_cash":7664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiber Optiguide","code_information":[{"code":"02350138","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6086.0,"discounted_cash":3043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Kyphon Kurce","code_information":[{"code":"02350144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Brush Disc Prep","code_information":[{"code":"02350147","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7328.0,"discounted_cash":3664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg","code_information":[{"code":"02350148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4760.0,"discounted_cash":2380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Esophageal Agile","code_information":[{"code":"02350151","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17110.0,"discounted_cash":8555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Localizer Surgical Probe","code_information":[{"code":"02350158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2027.6,"discounted_cash":1013.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Long Threaded Awl","code_information":[{"code":"02350163","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":806.6,"discounted_cash":403.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Hip Implant","code_information":[{"code":"02350164","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":214150.0,"discounted_cash":107075.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02350183","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":4250.0,"discounted_cash":2125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Bifuration Dumon","code_information":[{"code":"02350186","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":6752.0,"discounted_cash":3376.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Revolve Bone Access","code_information":[{"code":"02350190_111453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle Revolve Bone Access","code_information":[{"code":"02350190","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spring Clip","code_information":[{"code":"02350193","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2945.2,"discounted_cash":1472.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350194","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":1502.2,"discounted_cash":751.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Screw","code_information":[{"code":"02350204","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16261.99,"discounted_cash":8131.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Resolution","code_information":[{"code":"02350219","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1669.22,"discounted_cash":834.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Space Oar Hydrogel","code_information":[{"code":"02350220","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Repair Device Urinary W/Sling","code_information":[{"code":"02350223","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":7379.2,"discounted_cash":3689.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Light Invuity Retractor Waveguide","code_information":[{"code":"02350224","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wrench Allen","code_information":[{"code":"02350226","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":902.8,"discounted_cash":451.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02350231","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":10080.0,"discounted_cash":5040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02350241","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":22166.3,"discounted_cash":11083.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biocartilage 1Cc","code_information":[{"code":"02350242","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":6664.0,"discounted_cash":3332.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Puros Bone Block","code_information":[{"code":"02350247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4406.4,"discounted_cash":2203.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Am 4Cm X 3Cm","code_information":[{"code":"02350250","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4196","type":"HCPCS"}],"standard_charges":[{"gross_charge":8000.0,"discounted_cash":4000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02350256","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":26134.64,"discounted_cash":13067.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer Ravitrac","code_information":[{"code":"02350257","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2484.48,"discounted_cash":1242.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dental Implant","code_information":[{"code":"02350259","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2284.38,"discounted_cash":1142.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02350264","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8428.8,"discounted_cash":4214.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Otologic Mesh","code_information":[{"code":"02350269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02350274","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":63600.0,"discounted_cash":31800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02350280_127820","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02350280","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02350284_105027","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02350284_113082","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02350284_3584838","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibertak Dx Kit Disposable","code_information":[{"code":"02350284","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Silo Bag 3 Or 4 Cm Sterile","code_information":[{"code":"02350285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2612.2,"discounted_cash":1306.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occluder  Septal Cribiform Amplatzer","code_information":[{"code":"02350287","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":44167.2,"discounted_cash":22083.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occluder Pfo Amplatzer","code_information":[{"code":"02350288","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1817","type":"HCPCS"}],"standard_charges":[{"gross_charge":55300.0,"discounted_cash":27650.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coronary Catheter","code_information":[{"code":"02350291","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1761","type":"HCPCS"}],"standard_charges":[{"gross_charge":27730.0,"discounted_cash":13865.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulse Generator Phrenic Remede","code_information":[{"code":"02350292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1823","type":"HCPCS"}],"standard_charges":[{"gross_charge":127500.0,"discounted_cash":63750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Phrenic Nerve Stimulator","code_information":[{"code":"02350293","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":50400.0,"discounted_cash":25200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Femoral Confyle Hemi","code_information":[{"code":"02350294","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":97850.0,"discounted_cash":48925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Planrar Fascia Release System","code_information":[{"code":"02350297","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6086.0,"discounted_cash":3043.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprosthesis Viabil Biliary","code_information":[{"code":"02350299","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15340.0,"discounted_cash":7670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Button Kit Pectoralis Large","code_information":[{"code":"02350301","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10560.0,"discounted_cash":5280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle Direct Access","code_information":[{"code":"02350302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350304","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":16000.0,"discounted_cash":8000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Implant Hammertube","code_information":[{"code":"02350305","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9580.8,"discounted_cash":4790.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stapler Reload","code_information":[{"code":"02350306","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02350309","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":37464.0,"discounted_cash":18732.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pushlock Percutaneous Insertion Kit","code_information":[{"code":"02350310","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laser Fiber","code_information":[{"code":"02350318","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6758.4,"discounted_cash":3379.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knot Pusher","code_information":[{"code":"02350319_113793","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Knot Pusher","code_information":[{"code":"02350319","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteochondral Autogr Trans Sys","code_information":[{"code":"02350323","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Matrix 10Cc","code_information":[{"code":"02350326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":37200.8,"discounted_cash":18600.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nut Cps Salvage","code_information":[{"code":"02350329","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2360.6,"discounted_cash":1180.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing System Pico","code_information":[{"code":"02350332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sizer Mammary","code_information":[{"code":"02350346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":814.0,"discounted_cash":407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Valve Endobronchial","code_information":[{"code":"02350348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15872.0,"discounted_cash":7936.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Smoke Evacuator","code_information":[{"code":"02350350","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02350354","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1072.26,"discounted_cash":536.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Access System Sheathless Railway","code_information":[{"code":"02350355","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg Endovive Enfit","code_information":[{"code":"02350356_114601","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Peg Endovive Enfit","code_information":[{"code":"02350356_121676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Peg Endovive Enfit","code_information":[{"code":"02350356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":549.5,"discounted_cash":274.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cassette Veriflow","code_information":[{"code":"02350357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":431.75,"discounted_cash":215.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bulkamid Urethral Bulking","code_information":[{"code":"02350360","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8606","type":"HCPCS"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bulkamid Urethral Bulking","code_information":[{"code":"02350360_114604","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8606","type":"HCPCS"}],"standard_charges":[{"gross_charge":7360.0,"discounted_cash":3680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patient Trial Kit Wavewriter Alpha","code_information":[{"code":"02350363_114656","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patient Trial Kit Wavewriter Alpha","code_information":[{"code":"02350363","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wedge Evans","code_information":[{"code":"02350364","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":14048.0,"discounted_cash":7024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Prosth Reservoir","code_information":[{"code":"02350367","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7020.03,"discounted_cash":3510.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02350368","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":5834.4,"discounted_cash":2917.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patch Cardiovascular","code_information":[{"code":"02350373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":5130.19,"discounted_cash":2565.10,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Excluder Conformable","code_information":[{"code":"02350381","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":71947.5,"discounted_cash":35973.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Spacer","code_information":[{"code":"02350384","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1727.0,"discounted_cash":863.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02350386","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":79500.0,"discounted_cash":39750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Guide Kit","code_information":[{"code":"02350391","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6276.4,"discounted_cash":3138.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Lift Reposition System","code_information":[{"code":"02350392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1657.6,"discounted_cash":828.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Grasper Cap Adapter","code_information":[{"code":"02350397","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2216.3,"discounted_cash":1108.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Epifix 18Mm","code_information":[{"code":"02350398","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4186","type":"HCPCS"}],"standard_charges":[{"gross_charge":4394.3,"discounted_cash":2197.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tel Dbm Allosync","code_information":[{"code":"02350400_121580","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tel Dbm Allosync","code_information":[{"code":"02350400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Confidence Spinal Cement System","code_information":[{"code":"02350401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8960.0,"discounted_cash":4480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cement Quickset Macroporous","code_information":[{"code":"02350402_102984","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9856.0,"discounted_cash":4928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cement Quickset Macroporous","code_information":[{"code":"02350402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9856.0,"discounted_cash":4928.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Thick Acellular Dermal Matrix","code_information":[{"code":"02350403","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":22980.5,"discounted_cash":11490.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissuemend","code_information":[{"code":"02350405","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":18625.42,"discounted_cash":9312.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02350411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1001.66,"discounted_cash":500.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clarifix Cryotherapy Device","code_information":[{"code":"02350414","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":10208.0,"discounted_cash":5104.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neonate Zflo Positioner","code_information":[{"code":"02350416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":820.96,"discounted_cash":410.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ascope Rhinolaryngoscope","code_information":[{"code":"02350417_113785","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ascope Rhinolaryngoscope","code_information":[{"code":"02350417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1628.0,"discounted_cash":814.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Direx","code_information":[{"code":"02350421","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5623.6,"discounted_cash":2811.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coupler Flow","code_information":[{"code":"02350425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6688.0,"discounted_cash":3344.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Neurostim Test Kit","code_information":[{"code":"02350427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":1924.0,"discounted_cash":962.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc End Cap","code_information":[{"code":"02350428","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7745.47,"discounted_cash":3872.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Block Demineralized Cancellous","code_information":[{"code":"02350429","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4182.0,"discounted_cash":2091.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Demin Allocell Graft 2.5Cc","code_information":[{"code":"02350432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4802.84,"discounted_cash":2401.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Demin Allocell Graft 5Cc","code_information":[{"code":"02350433","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8057.6,"discounted_cash":4028.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Demin Allocell Graft 10Cc","code_information":[{"code":"02350434","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12281.6,"discounted_cash":6140.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Small Patch Sensor","code_information":[{"code":"02350436","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10176.0,"discounted_cash":5088.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Microintroducer Galt 7Cm","code_information":[{"code":"02350437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1383.8,"discounted_cash":691.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embolization Protective System","code_information":[{"code":"02350438","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":5166.64,"discounted_cash":2583.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sonopet Suction Irrigation","code_information":[{"code":"02350439","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3683.7,"discounted_cash":1841.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Occlusion","code_information":[{"code":"02350440","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2628","type":"HCPCS"}],"standard_charges":[{"gross_charge":17025.93,"discounted_cash":8512.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inspace Us Balloon","code_information":[{"code":"02350442","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":44520.0,"discounted_cash":22260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ecmo Oxygenator","code_information":[{"code":"02350445","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":23600.0,"discounted_cash":11800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stone Extractor","code_information":[{"code":"02350448","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1111.85,"discounted_cash":555.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350451","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":10432.0,"discounted_cash":5216.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Grafton Dbf Inject 9Cc","code_information":[{"code":"02350453","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12544.0,"discounted_cash":6272.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Humanitarian Device Stent Intracranial","code_information":[{"code":"02350457","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":40600.0,"discounted_cash":20300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Oats Disposable Kit","code_information":[{"code":"02350459","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Swiss Lithoclast Trilogy Probe","code_information":[{"code":"02350460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5303.46,"discounted_cash":2651.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pulse Nerve Stimulator","code_information":[{"code":"02350464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1823","type":"HCPCS"}],"standard_charges":[{"gross_charge":137500.0,"discounted_cash":68750.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02350466","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":992.78,"discounted_cash":496.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoprobe","code_information":[{"code":"02350471","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":3226.4,"discounted_cash":1613.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoprobe","code_information":[{"code":"02350472","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2618","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Thoracic","code_information":[{"code":"02350477","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":102375.0,"discounted_cash":51187.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Delivery System Amplatzer","code_information":[{"code":"02350480","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6507.6,"discounted_cash":3253.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extension Percutaneous Axonics Implant","code_information":[{"code":"02350481_110326","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.6,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Extension Percutaneous Axonics Implant","code_information":[{"code":"02350481","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1883","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.6,"discounted_cash":376.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_127178","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_127443","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_127924","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128060","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128061","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128166","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128168","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128191","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128210","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128249","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128253","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_128294","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_129512","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_129876","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02350482_129877","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Arterial Swan-Ganz","code_information":[{"code":"02350487","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2479.0,"discounted_cash":1239.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bag Tissue Retrieval","code_information":[{"code":"02350489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Angiographic Wedge","code_information":[{"code":"02350491","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.0,"discounted_cash":573.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tendon Semitendinosus","code_information":[{"code":"02350492_116760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10080.0,"discounted_cash":5040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tendon Semitendinosus","code_information":[{"code":"02350492","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10080.0,"discounted_cash":5040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Intravascular Us","code_information":[{"code":"02350493_116762","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Intravascular Us","code_information":[{"code":"02350493","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1753","type":"HCPCS"}],"standard_charges":[{"gross_charge":5440.0,"discounted_cash":2720.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neuroendoscope","code_information":[{"code":"02350494","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14246.4,"discounted_cash":7123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02350496","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":7443.2,"discounted_cash":3721.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg","code_information":[{"code":"02350499","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2046.1,"discounted_cash":1023.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cement Delivery System","code_information":[{"code":"02350501","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3115.4,"discounted_cash":1557.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350509","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":392.58,"discounted_cash":196.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350510","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":421.78,"discounted_cash":210.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350510_76878","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":421.78,"discounted_cash":210.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350511_106446","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":464.01,"discounted_cash":232.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350511_129169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":464.01,"discounted_cash":232.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350511","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":464.01,"discounted_cash":232.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350512","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":510.49,"discounted_cash":255.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350513","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":561.59,"discounted_cash":280.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350514_128610","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":617.87,"discounted_cash":308.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350514_66450","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":617.87,"discounted_cash":308.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350514_78596","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":617.87,"discounted_cash":308.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350514","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":617.87,"discounted_cash":308.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350515","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":679.73,"discounted_cash":339.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350516_76709","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":747.79,"discounted_cash":373.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350516","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":747.79,"discounted_cash":373.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350517_79270","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.45,"discounted_cash":387.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350517","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":775.45,"discounted_cash":387.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350518_101552","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.07,"discounted_cash":426.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350518_109854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.07,"discounted_cash":426.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350518_83144","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.07,"discounted_cash":426.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":853.07,"discounted_cash":426.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350519_130518","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":938.47,"discounted_cash":469.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350519","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":938.47,"discounted_cash":469.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350520_129485","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1032.37,"discounted_cash":516.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350520","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1032.37,"discounted_cash":516.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350521_129486","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1135.68,"discounted_cash":567.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1135.68,"discounted_cash":567.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350522","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1249.34,"discounted_cash":624.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350523_130120","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1374.33,"discounted_cash":687.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350523","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1374.33,"discounted_cash":687.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350524","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1511.82,"discounted_cash":755.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350525","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1663.08,"discounted_cash":831.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350526","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1829.5,"discounted_cash":914.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350527_117214","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2012.5,"discounted_cash":1006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350527","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2012.5,"discounted_cash":1006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350528","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2213.86,"discounted_cash":1106.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350529","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2435.27,"discounted_cash":1217.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350530","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2678.87,"discounted_cash":1339.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350531_117464","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2946.83,"discounted_cash":1473.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350531_129026","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2946.83,"discounted_cash":1473.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350531","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2946.83,"discounted_cash":1473.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350532","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3241.57,"discounted_cash":1620.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350533","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3565.84,"discounted_cash":1782.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Guiding/Temporary","code_information":[{"code":"02350538","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5277.62,"discounted_cash":2638.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.87,"discounted_cash":308.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":747.79,"discounted_cash":373.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.07,"discounted_cash":426.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350569_110653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.47,"discounted_cash":469.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350569","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":938.47,"discounted_cash":469.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1135.68,"discounted_cash":567.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1249.34,"discounted_cash":624.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.33,"discounted_cash":687.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1511.82,"discounted_cash":755.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1663.08,"discounted_cash":831.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2012.5,"discounted_cash":1006.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350578","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2213.86,"discounted_cash":1106.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350579","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2435.28,"discounted_cash":1217.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350581_128731","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2946.83,"discounted_cash":1473.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350581","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2946.83,"discounted_cash":1473.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350592","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7272.7,"discounted_cash":3636.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pin Implant","code_information":[{"code":"02350594","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8800.13,"discounted_cash":4400.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02350603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":41913.26,"discounted_cash":20956.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Cup","code_information":[{"code":"02350606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2648.8,"discounted_cash":1324.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02350608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":682.83,"discounted_cash":341.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Patella","code_information":[{"code":"02350609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.14,"discounted_cash":375.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Tibial","code_information":[{"code":"02350610","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":635.86,"discounted_cash":317.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02350615","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":784.96,"discounted_cash":392.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02350620","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3422.15,"discounted_cash":1711.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor","code_information":[{"code":"02350623_104091","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":438.98,"discounted_cash":219.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Retractor","code_information":[{"code":"02350623_3580138","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":470.61,"discounted_cash":235.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retractor","code_information":[{"code":"02350623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":470.61,"discounted_cash":235.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dbm Chips","code_information":[{"code":"02350624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5814.0,"discounted_cash":2907.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mastergraft Strip","code_information":[{"code":"02350626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":25440.8,"discounted_cash":12720.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350630","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.23,"discounted_cash":388.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350634","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1073.05,"discounted_cash":536.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350636","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1298.55,"discounted_cash":649.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350640","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1901.58,"discounted_cash":950.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350641","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.76,"discounted_cash":1045.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350645","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3062.93,"discounted_cash":1531.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350646_128627","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3369.29,"discounted_cash":1684.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350646","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3369.29,"discounted_cash":1684.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3405.78,"discounted_cash":1702.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350648_130891","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3746.42,"discounted_cash":1873.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350648","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3746.42,"discounted_cash":1873.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4533.29,"discounted_cash":2266.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4986.71,"discounted_cash":2493.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350652","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5485.42,"discounted_cash":2742.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6034.05,"discounted_cash":3017.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350654_117857","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.55,"discounted_cash":3318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350654_117919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.55,"discounted_cash":3318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350654_128625","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.55,"discounted_cash":3318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350654_128626","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.55,"discounted_cash":3318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350654","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6637.55,"discounted_cash":3318.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350655","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6871.87,"discounted_cash":3435.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350656","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7559.1,"discounted_cash":3779.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350657","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":8315.07,"discounted_cash":4157.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350658_121927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9146.62,"discounted_cash":4573.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350658_128733","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9146.62,"discounted_cash":4573.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350658_129552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9146.62,"discounted_cash":4573.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350658","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9146.62,"discounted_cash":4573.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":10061.38,"discounted_cash":5030.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_117856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_117918","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_127239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_128624","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_128730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350660_130890","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":11067.58,"discounted_cash":5533.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350661_128628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12174.4,"discounted_cash":6087.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350661_130926","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12174.4,"discounted_cash":6087.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350661","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":12174.4,"discounted_cash":6087.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350662_117877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13391.94,"discounted_cash":6695.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350662_128732","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13391.94,"discounted_cash":6695.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350662","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13391.94,"discounted_cash":6695.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663_128623","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663_129318","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663_130427","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663_130927","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663_131190","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350663","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14731.2,"discounted_cash":7365.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350664","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14938.39,"discounted_cash":7469.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_117855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_117920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_129218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_129653","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_130135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665_131191","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350665","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":16432.27,"discounted_cash":8216.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350666","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":18075.59,"discounted_cash":9037.80,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350667","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19883.18,"discounted_cash":9941.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350668","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21871.54,"discounted_cash":10935.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":24058.78,"discounted_cash":12029.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02350670_130924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":26464.69,"discounted_cash":13232.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02350670_130925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":26464.69,"discounted_cash":13232.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":30394.17,"discounted_cash":15197.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":33433.62,"discounted_cash":16716.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shoulder Implant","code_information":[{"code":"02350681","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":67829.24,"discounted_cash":33914.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urolift Atc","code_information":[{"code":"02350688_119407","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6560.0,"discounted_cash":3280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Urolift Atc","code_information":[{"code":"02350688_124704","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6560.0,"discounted_cash":3280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Urolift Atc","code_information":[{"code":"02350688","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6560.0,"discounted_cash":3280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myosure Devise","code_information":[{"code":"02350699","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1782","type":"HCPCS"}],"standard_charges":[{"gross_charge":8401.49,"discounted_cash":4200.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiber Laser Flexiva","code_information":[{"code":"02350704","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4565.93,"discounted_cash":2282.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elevator Passing Tool","code_information":[{"code":"02350713","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":932.4,"discounted_cash":466.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Imobllizer","code_information":[{"code":"02350722","type":"CDM"},{"code":"274","type":"RC"},{"code":"L1830","type":"HCPCS"}],"standard_charges":[{"gross_charge":563.94,"discounted_cash":281.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Boot Walking","code_information":[{"code":"02350734_L4386_274","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1155.77,"discounted_cash":577.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Boot Walking","code_information":[{"code":"02350734","type":"CDM"},{"code":"274","type":"RC"},{"code":"L4386","type":"HCPCS"}],"standard_charges":[{"gross_charge":1126.43,"discounted_cash":563.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Repair Device Urinary W/Sling","code_information":[{"code":"02350740","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":7703.81,"discounted_cash":3851.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Neonatal Double Lumen","code_information":[{"code":"02350742","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":775.45,"discounted_cash":387.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wnd Matrix Dressing","code_information":[{"code":"02350744","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4108","type":"HCPCS"}],"standard_charges":[{"gross_charge":32342.35,"discounted_cash":16171.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Self Expanding","code_information":[{"code":"02350745","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3256.0,"discounted_cash":1628.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Fluent Fluid Management System","code_information":[{"code":"02350746","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02350749","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":7942.4,"discounted_cash":3971.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Airtapp Xxl System Turn And Lift","code_information":[{"code":"02350751","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2146.0,"discounted_cash":1073.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02350753","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":19228.1,"discounted_cash":9614.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Interstim Neutostimulator","code_information":[{"code":"02350755","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":67134.78,"discounted_cash":33567.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calibration Visigi With Bulb","code_information":[{"code":"02350757","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1768.6,"discounted_cash":884.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Conflow","code_information":[{"code":"02350758","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.69,"discounted_cash":325.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cenment Conflow W/ Gent","code_information":[{"code":"02350759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2251.23,"discounted_cash":1125.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Intercranial","code_information":[{"code":"02350760","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":83510.0,"discounted_cash":41755.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Preveleak Sealant","code_information":[{"code":"02350763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4636.65,"discounted_cash":2318.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350765","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":14425.6,"discounted_cash":7212.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Polysaccharide Hemostatic Endoclot 5G","code_information":[{"code":"02350767","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1052","type":"HCPCS"}],"standard_charges":[{"gross_charge":13953.6,"discounted_cash":6976.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nannoscope Camera Head And Cable","code_information":[{"code":"02350776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4481.2,"discounted_cash":2240.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Duraseal Extended Applicator","code_information":[{"code":"02350779","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2192.29,"discounted_cash":1096.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Procinch Adjus Loop Impt Stand Tens","code_information":[{"code":"02350780","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4685.2,"discounted_cash":2342.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteoballast Dbm In Mesh","code_information":[{"code":"02350781","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6419.2,"discounted_cash":3209.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clamp Encompass","code_information":[{"code":"02350785","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":30240.0,"discounted_cash":15120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Senza Omnia Ipg","code_information":[{"code":"02350789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1822","type":"HCPCS"}],"standard_charges":[{"gross_charge":135000.0,"discounted_cash":67500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Coronary Onyx Eluting","code_information":[{"code":"02350790_3582967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent Coronary Onyx Eluting","code_information":[{"code":"02350790","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon Dilation Drug-Coated","code_information":[{"code":"02350794","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sling","code_information":[{"code":"02350797","type":"CDM"},{"code":"274","type":"RC"},{"code":"L3670","type":"HCPCS"}],"standard_charges":[{"gross_charge":452.24,"discounted_cash":226.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Amplatzer","code_information":[{"code":"02350799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6256.0,"discounted_cash":3128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Northstar Fusion Kit","code_information":[{"code":"02350803","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bipolar Forceps","code_information":[{"code":"02350804","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7891.2,"discounted_cash":3945.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Electrophysiology","code_information":[{"code":"02350805","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":15635.0,"discounted_cash":7817.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02350812","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6038.4,"discounted_cash":3019.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil Embolization","code_information":[{"code":"02350813","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6718.4,"discounted_cash":3359.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Biopsy Dyphon 13Ga","code_information":[{"code":"02350816","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shim Retractor","code_information":[{"code":"02350817","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3597.2,"discounted_cash":1798.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Easy Spray","code_information":[{"code":"02350818","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":999.46,"discounted_cash":499.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comformis Custom Knee Imprint","code_information":[{"code":"02350820","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":22420.0,"discounted_cash":11210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02350822","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":2234.8,"discounted_cash":1117.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Electrophysiology","code_information":[{"code":"02350823","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":843.6,"discounted_cash":421.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Defib Biventricular","code_information":[{"code":"02350825","type":"CDM"},{"code":"275","type":"RC"},{"code":"C1882","type":"HCPCS"}],"standard_charges":[{"gross_charge":89537.5,"discounted_cash":44768.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic Evolut","code_information":[{"code":"02350826","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":150000.0,"discounted_cash":75000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Evolut Delivery System","code_information":[{"code":"02350827","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":13504.0,"discounted_cash":6752.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Evolut Loading System","code_information":[{"code":"02350828","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2886.0,"discounted_cash":1443.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Remover Bone Screw Inbone Reamer","code_information":[{"code":"02350831","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":828.8,"discounted_cash":414.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350833_100302","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02350833","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02350835_130928","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":499.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cath Esaphogeal Temp","code_information":[{"code":"02350836","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5778.3,"discounted_cash":2889.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02350837","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":20355.0,"discounted_cash":10177.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endo Clip","code_information":[{"code":"02350838","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5623.6,"discounted_cash":2811.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carter Closure","code_information":[{"code":"02350839_120053","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1058.94,"discounted_cash":529.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Carter Closure","code_information":[{"code":"02350839","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1058.94,"discounted_cash":529.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02350840","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":9590.08,"discounted_cash":4795.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Lead Sacromodulation Tined","code_information":[{"code":"02350842","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1778","type":"HCPCS"}],"standard_charges":[{"gross_charge":25851.56,"discounted_cash":12925.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Mantis","code_information":[{"code":"02350845","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Plug","code_information":[{"code":"02350847","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1516.63,"discounted_cash":758.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Non Laser","code_information":[{"code":"02350848","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":5077.08,"discounted_cash":2538.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit For Volara Or Meta Neb","code_information":[{"code":"02350849","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":737.9,"discounted_cash":368.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Set Bunion Tailors Broach","code_information":[{"code":"02350852","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1783.4,"discounted_cash":891.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Bunion Tailors Small","code_information":[{"code":"02350853","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8672.0,"discounted_cash":4336.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Circuit Breathing Airvo","code_information":[{"code":"02350854","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":541.65,"discounted_cash":270.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02350855","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15200.0,"discounted_cash":7600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wrist Radial Head","code_information":[{"code":"02350856","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14464.0,"discounted_cash":7232.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shunt Sundt","code_information":[{"code":"02350859","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4419.32,"discounted_cash":2209.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shim Disc","code_information":[{"code":"02350862","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3263.4,"discounted_cash":1631.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bronchoscopeflexible","code_information":[{"code":"02350866","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Supernova Mask","code_information":[{"code":"02350868","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":643.7,"discounted_cash":321.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02350872","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":10624.0,"discounted_cash":5312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Putty Injectable 1Cc Beast 100","code_information":[{"code":"02350873_120695","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Putty Injectable 1Cc Beast 100","code_information":[{"code":"02350873","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02350874","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":4046.0,"discounted_cash":2023.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02350875_22028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.06,"discounted_cash":302.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Liner","code_information":[{"code":"02350875_24044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.06,"discounted_cash":302.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Liner","code_information":[{"code":"02350875_64901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.06,"discounted_cash":302.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Hip Liner","code_information":[{"code":"02350875","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.06,"discounted_cash":302.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02350876","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1650.0,"discounted_cash":825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02350877","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1818.08,"discounted_cash":909.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02350878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.97,"discounted_cash":999.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02350892","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14628.9,"discounted_cash":7314.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Rod","code_information":[{"code":"02350893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16091.86,"discounted_cash":8045.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Orthocord With Needle","code_information":[{"code":"02350896","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4644.4,"discounted_cash":2322.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adapter Sealing Attain","code_information":[{"code":"02350897","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Endoprosthesis","code_information":[{"code":"02350899","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":22933.3,"discounted_cash":11466.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02350901","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6575.6,"discounted_cash":3287.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02350903_91357","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle","code_information":[{"code":"02350903","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1443.0,"discounted_cash":721.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02350904_112418","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1691.64,"discounted_cash":845.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Needle","code_information":[{"code":"02350904","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1691.64,"discounted_cash":845.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Needle","code_information":[{"code":"02350904_129332","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1691.64,"discounted_cash":845.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02350909","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.43,"discounted_cash":379.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Repair Device Urinary W/Sling","code_information":[{"code":"02350911","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1771","type":"HCPCS"}],"standard_charges":[{"gross_charge":6768.7,"discounted_cash":3384.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02350913","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteotome","code_information":[{"code":"02350917","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2792.76,"discounted_cash":1396.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Matrix","code_information":[{"code":"02350919_125195","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22968.7,"discounted_cash":11484.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Matrix","code_information":[{"code":"02350919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22968.7,"discounted_cash":11484.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02350920","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7456.0,"discounted_cash":3728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent","code_information":[{"code":"02350924","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":16785.5,"discounted_cash":8392.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mammary Implant","code_information":[{"code":"02350925","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1789","type":"HCPCS"}],"standard_charges":[{"gross_charge":6976.0,"discounted_cash":3488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pro Dense Injectable","code_information":[{"code":"02350929","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17930.1,"discounted_cash":8965.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sizer Handle","code_information":[{"code":"02350931","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Auditory Osseointegrated Device","code_information":[{"code":"02350934","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8690","type":"HCPCS"}],"standard_charges":[{"gross_charge":28028.0,"discounted_cash":14014.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Illumination System Mars","code_information":[{"code":"02350937","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15884.8,"discounted_cash":7942.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Strap Pt Standard Mac Sys","code_information":[{"code":"02350938","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Endovascular","code_information":[{"code":"02350946","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":48540.8,"discounted_cash":24270.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closer Device Slingshot","code_information":[{"code":"02350949","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2091.91,"discounted_cash":1045.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Nexpowder Hemostasis System","code_information":[{"code":"02350956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1052","type":"HCPCS"}],"standard_charges":[{"gross_charge":5460.4,"discounted_cash":2730.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Membrane Amniotic","code_information":[{"code":"02350959","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":14313.6,"discounted_cash":7156.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vascular","code_information":[{"code":"02350960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":14080.0,"discounted_cash":7040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retriever Trevo","code_information":[{"code":"02350963","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":46200.0,"discounted_cash":23100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Transluminal Atherectomy","code_information":[{"code":"02350964","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1724","type":"HCPCS"}],"standard_charges":[{"gross_charge":20030.5,"discounted_cash":10015.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Endowrist","code_information":[{"code":"02350969","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5854.8,"discounted_cash":2927.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Human Mem Affin 1.5 X 1.5Cm","code_information":[{"code":"02350972","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4159","type":"HCPCS"}],"standard_charges":[{"gross_charge":8640.0,"discounted_cash":4320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Purastat Hemostasis","code_information":[{"code":"02350974","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02350975","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":11520.0,"discounted_cash":5760.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Peg Endovive Enfit","code_information":[{"code":"02350976","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":902.8,"discounted_cash":451.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hammer Toe Implant","code_information":[{"code":"02350978","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15911.42,"discounted_cash":7955.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02350980","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":6630.0,"discounted_cash":3315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Lens Posterior Chamber","code_information":[{"code":"02350983","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":3552.0,"discounted_cash":1776.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Lens Posterior Chamber","code_information":[{"code":"02350984","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2632","type":"HCPCS"}],"standard_charges":[{"gross_charge":1332.0,"discounted_cash":666.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tip Sonopet Iq Standard","code_information":[{"code":"02350986","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6542.1,"discounted_cash":3271.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Procinch Slotted Botton","code_information":[{"code":"02350991","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.54,"discounted_cash":1394.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Healing Cylinder","code_information":[{"code":"02350992","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":12160.0,"discounted_cash":6080.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Opra Implant Fixture","code_information":[{"code":"02350994","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":120000.0,"discounted_cash":60000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cystoscope Disposable Ascope","code_information":[{"code":"02350997","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hook Stay Lone Star","code_information":[{"code":"02350998","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":467.94,"discounted_cash":233.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiber Imperium","code_information":[{"code":"02350999","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":12953.6,"discounted_cash":6476.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Neurostim Test Kit","code_information":[{"code":"02351001","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead Neurostim Test Kit","code_information":[{"code":"02351002","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1897","type":"HCPCS"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iassist V2 Pod","code_information":[{"code":"02351003","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7452.8,"discounted_cash":3726.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patch Sensor","code_information":[{"code":"02351007","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10176.0,"discounted_cash":5088.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing Prevena","code_information":[{"code":"02351009","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1964.7,"discounted_cash":982.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manipulator Uterine","code_information":[{"code":"02351010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1361.6,"discounted_cash":680.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Impella Pump Set","code_information":[{"code":"02351011","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":225000.0,"discounted_cash":112500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Implant Model","code_information":[{"code":"02351013","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10880.0,"discounted_cash":5440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate Cover","code_information":[{"code":"02351014","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02351015_124790","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Astigmatism Correcting","code_information":[{"code":"02351015","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2787","type":"HCPCS"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Obsidio Embolic","code_information":[{"code":"02351016","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":22420.0,"discounted_cash":11210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Device Colpassist","code_information":[{"code":"02351018","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2519.85,"discounted_cash":1259.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Platelet Rich Plasma Kit","code_information":[{"code":"02351019","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occluder Duct Amplatzer","code_information":[{"code":"02351020","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29859.2,"discounted_cash":14929.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Guiding","code_information":[{"code":"02351026","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02351028","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":50400.0,"discounted_cash":25200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Swivelock Disp Kit Cannula","code_information":[{"code":"02351030","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02351031","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":3681.5,"discounted_cash":1840.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Disposable Instrument Kit Colink Dense Bone","code_information":[{"code":"02351032","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5922.8,"discounted_cash":2961.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ream Rod Ball Tip","code_information":[{"code":"02351033","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1335.33,"discounted_cash":667.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail Extraction Adapter","code_information":[{"code":"02351038","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2466.42,"discounted_cash":1233.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Jada Intrauterine Device","code_information":[{"code":"02351041_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8928.0,"discounted_cash":4464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Jada Intrauterine Device","code_information":[{"code":"02351041","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8928.0,"discounted_cash":4464.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02351042","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1732","type":"HCPCS"}],"standard_charges":[{"gross_charge":26408.4,"discounted_cash":13204.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Extension Q-Dot","code_information":[{"code":"02351043","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5834.4,"discounted_cash":2917.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patient Positioner","code_information":[{"code":"02351048","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Handpiece Brst Bx Atec 12 Cm 9-12Ga 20 Mm","code_information":[{"code":"02351049","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1776.0,"discounted_cash":888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Photodynamic Bone Stabilization System","code_information":[{"code":"02351050","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":24349.42,"discounted_cash":12174.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Photodynamic Bone Stabilization System","code_information":[{"code":"02351051","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":28656.71,"discounted_cash":14328.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suturing Device Fixate Tissue Band","code_information":[{"code":"02351052_123381","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Suturing Device Fixate Tissue Band","code_information":[{"code":"02351052","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Implant Bolt Expansion","code_information":[{"code":"02351055","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2338.4,"discounted_cash":1169.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Ring Support For Stem","code_information":[{"code":"02351056","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5671.2,"discounted_cash":2835.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Disposable Access Kit","code_information":[{"code":"02351057","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5406.0,"discounted_cash":2703.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Matrix Tissue Axiofill","code_information":[{"code":"02351058","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":14517.06,"discounted_cash":7258.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mavix Concentrated Protein Matrix","code_information":[{"code":"02351059","type":"CDM"},{"code":"623","type":"RC"},{"code":"A6010","type":"HCPCS"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Paste Beads","code_information":[{"code":"02351064","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4437.68,"discounted_cash":2218.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biologic Infill Afm Advanced Fusion Matrix","code_information":[{"code":"02351065","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5066.0,"discounted_cash":2533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Power Pulse Spike Set","code_information":[{"code":"02351073","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":612.3,"discounted_cash":306.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter/Stent Pusher","code_information":[{"code":"02351077","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":394.23,"discounted_cash":197.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Pelvis Custom Implant","code_information":[{"code":"02351083","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":166400.0,"discounted_cash":83200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02351084","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1893","type":"HCPCS"}],"standard_charges":[{"gross_charge":4080.0,"discounted_cash":2040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Osteo Introducer Kyphon","code_information":[{"code":"02351090","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cassette Head For Expandor Disp","code_information":[{"code":"02351091","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":533.8,"discounted_cash":266.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Spacer","code_information":[{"code":"02351095","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2298.84,"discounted_cash":1149.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Spacer","code_information":[{"code":"02351097","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":2579.43,"discounted_cash":1289.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Marking Guide","code_information":[{"code":"02351101","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":29393.8,"discounted_cash":14696.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Cranial Model","code_information":[{"code":"02351102","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":19470.0,"discounted_cash":9735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Extractor Nail","code_information":[{"code":"02351103","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2553.0,"discounted_cash":1276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tip Male Female Nail Extraction","code_information":[{"code":"02351104","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2109.0,"discounted_cash":1054.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Mitral Mitris Resilia","code_information":[{"code":"02351105","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":43652.0,"discounted_cash":21826.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Wrap Altrix Torso Thigh Complete","code_information":[{"code":"02351110","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":931.22,"discounted_cash":465.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Washer Lckg Attach Rfna","code_information":[{"code":"02351112","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8170.56,"discounted_cash":4085.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sealant Dural Synthetic","code_information":[{"code":"02351113","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6721.05,"discounted_cash":3360.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ultratape Suture","code_information":[{"code":"02351114","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":447.45,"discounted_cash":223.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02351116","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":37044.0,"discounted_cash":18522.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Procedure Bone Tx Pack","code_information":[{"code":"02351117","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8288.0,"discounted_cash":4144.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Sizing","code_information":[{"code":"02351118","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1041.18,"discounted_cash":520.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Retention Pannus","code_information":[{"code":"02351119","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":553.43,"discounted_cash":276.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Covered Vascular","code_information":[{"code":"02351121","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":22125.0,"discounted_cash":11062.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":588.75,"discounted_cash":294.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351126_127269","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.89,"discounted_cash":391.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351126","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":783.89,"discounted_cash":391.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351133_77775","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.71,"discounted_cash":720.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351133","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1440.71,"discounted_cash":720.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351134","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.85,"discounted_cash":792.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351134_82464","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1584.85,"discounted_cash":792.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1743.41,"discounted_cash":871.70,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351137","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2109.68,"discounted_cash":1054.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351138","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2320.72,"discounted_cash":1160.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351139_113081","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.87,"discounted_cash":1276.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2552.87,"discounted_cash":1276.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_124901","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_126893","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_127237","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_128238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_128239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140_89317","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351140","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2808.23,"discounted_cash":1404.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_101475","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_104809","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_105028","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_113130","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_122135","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_127843","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_128120","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_128238","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_128239","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_128671","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_3585651","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_3610789","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351141_94497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3089.13,"discounted_cash":1544.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_109275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_111143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_113932","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_119129","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_127851","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_128200","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_128573","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_129043","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_129044","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_129608","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142_3584996","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351142","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3398.12,"discounted_cash":1699.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351143_120236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.92,"discounted_cash":1717.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351143_129217","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.92,"discounted_cash":1717.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.92,"discounted_cash":1717.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_121045","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_126411","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_127958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_128236","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_128241","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_128243","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144_94497","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351144","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3778.48,"discounted_cash":1889.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351145","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4156.4,"discounted_cash":2078.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351146_112161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4572.1,"discounted_cash":2286.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351146_117628","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4572.1,"discounted_cash":2286.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351146","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":4572.1,"discounted_cash":2286.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351147","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5029.38,"discounted_cash":2514.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351148","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":5532.39,"discounted_cash":2766.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351149","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6085.69,"discounted_cash":3042.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351150_128772","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6694.33,"discounted_cash":3347.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351150_130830","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6694.33,"discounted_cash":3347.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351150","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6694.33,"discounted_cash":3347.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351152","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7623.8,"discounted_cash":3811.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351153_122595","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8386.24,"discounted_cash":4193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351153","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":8386.24,"discounted_cash":4193.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351154_102543","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9224.93,"discounted_cash":4612.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351154_104825","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9224.93,"discounted_cash":4612.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351154_130206","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9224.93,"discounted_cash":4612.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351154","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":9224.93,"discounted_cash":4612.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351155","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":10147.49,"discounted_cash":5073.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351156","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":11162.3,"discounted_cash":5581.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351157","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":12278.59,"discounted_cash":6139.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351158","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13506.52,"discounted_cash":6753.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351160_126860","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15066.22,"discounted_cash":7533.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351160_129691","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15066.22,"discounted_cash":7533.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351160_129914","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15066.22,"discounted_cash":7533.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351160","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":15066.22,"discounted_cash":7533.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351161_128650","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16863.68,"discounted_cash":8431.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351161_129672","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16572.9,"discounted_cash":8286.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351161","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":16572.9,"discounted_cash":8286.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351162","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":18230.25,"discounted_cash":9115.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anchor Suture","code_information":[{"code":"02351163","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":20053.33,"discounted_cash":10026.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02351167","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1892","type":"HCPCS"}],"standard_charges":[{"gross_charge":565.2,"discounted_cash":282.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02351168","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":6589.2,"discounted_cash":3294.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Cinch Long","code_information":[{"code":"02351169","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":911.43,"discounted_cash":455.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pedicle Access Kit","code_information":[{"code":"02351171","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6412.4,"discounted_cash":3206.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cochlear Implant Processor","code_information":[{"code":"02351174","type":"CDM"},{"code":"278","type":"RC"},{"code":"L8614","type":"HCPCS"}],"standard_charges":[{"gross_charge":70124.3,"discounted_cash":35062.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tip Sonopet","code_information":[{"code":"02351175","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6487.29,"discounted_cash":3243.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guide Drop In Fiberlase","code_information":[{"code":"02351176","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02351178","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.3,"discounted_cash":386.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Chips Cancellous","code_information":[{"code":"02351179","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":4862.0,"discounted_cash":2431.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Hemostasis","code_information":[{"code":"02351182","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2590.0,"discounted_cash":1295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Flexhd Pliable","code_information":[{"code":"02351183","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":55384.52,"discounted_cash":27692.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Centralizer","code_information":[{"code":"02351185","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1457.8,"discounted_cash":728.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Angiographic","code_information":[{"code":"02351188_107521","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Angiographic","code_information":[{"code":"02351188_3589925","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1398.6,"discounted_cash":699.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Angiographic","code_information":[{"code":"02351188","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1480.0,"discounted_cash":740.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Tissuemend Collagen Matrix","code_information":[{"code":"02351190","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":16297.63,"discounted_cash":8148.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Pacing","code_information":[{"code":"02351191","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":962.0,"discounted_cash":481.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Bone Cement Mixing Kit","code_information":[{"code":"02351192_118177","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":863.81,"discounted_cash":431.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc System Bone Cement Mixing Kit","code_information":[{"code":"02351192","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":863.81,"discounted_cash":431.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiac Recorder","code_information":[{"code":"02351194","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1764","type":"HCPCS"}],"standard_charges":[{"gross_charge":27730.0,"discounted_cash":13865.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Suprapubic","code_information":[{"code":"02351195","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2627","type":"HCPCS"}],"standard_charges":[{"gross_charge":669.53,"discounted_cash":334.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Harvester","code_information":[{"code":"02351196","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6796.8,"discounted_cash":3398.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Biodesign Otologic Repair","code_information":[{"code":"02351197","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thrombectomy","code_information":[{"code":"02351201","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1757","type":"HCPCS"}],"standard_charges":[{"gross_charge":31416.0,"discounted_cash":15708.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02351202","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":9187.2,"discounted_cash":4593.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Instruments Disposable Arthroscopic","code_information":[{"code":"02351205","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02351208","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":13433.6,"discounted_cash":6716.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02351209","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":20408.1,"discounted_cash":10204.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Kyphopak","code_information":[{"code":"02351211","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":18703.0,"discounted_cash":9351.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Dural","code_information":[{"code":"02351214","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10319.36,"discounted_cash":5159.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02351217","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.2,"discounted_cash":399.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft","code_information":[{"code":"02351218","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1739.0,"discounted_cash":869.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Perfluoron","code_information":[{"code":"02351220","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3644.39,"discounted_cash":1822.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bag Tissue Retrieval","code_information":[{"code":"02351222_3582956","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":459.93,"discounted_cash":229.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bag Tissue Retrieval","code_information":[{"code":"02351222_51158","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":459.93,"discounted_cash":229.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bag Tissue Retrieval","code_information":[{"code":"02351222","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":459.93,"discounted_cash":229.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Fistula","code_information":[{"code":"02351224","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":9184.0,"discounted_cash":4592.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tlso Ots Custom","code_information":[{"code":"02351231","type":"CDM"},{"code":"274","type":"RC"},{"code":"L0456","type":"HCPCS"}],"standard_charges":[{"gross_charge":6788.98,"discounted_cash":3394.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Kit Restor","code_information":[{"code":"02351232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6290.0,"discounted_cash":3145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Steerable","code_information":[{"code":"02351236","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Cryo Gas","code_information":[{"code":"02351237","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":706.5,"discounted_cash":353.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable Polarmap Egm","code_information":[{"code":"02351238","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1369.0,"discounted_cash":684.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc  Cable Smartfreeze","code_information":[{"code":"02351239","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Lacrimal Duct","code_information":[{"code":"02351240","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":888.0,"discounted_cash":444.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade","code_information":[{"code":"02351243","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5780.0,"discounted_cash":2890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02351247","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":110030.0,"discounted_cash":55015.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Guide Tube Lunar Ovoid","code_information":[{"code":"02351251","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":815.14,"discounted_cash":407.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Percutaneous Drainage","code_information":[{"code":"02351252","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":527.52,"discounted_cash":263.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Casting Tcc-Ez 3/4In Single Application","code_information":[{"code":"02351254","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":895.4,"discounted_cash":447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scaffold Collagen","code_information":[{"code":"02351255","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":22715.0,"discounted_cash":11357.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Positioner Wedge","code_information":[{"code":"02351260","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":557.9,"discounted_cash":278.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Introducer Sheath","code_information":[{"code":"02351262","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":2220.0,"discounted_cash":1110.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Algrft Dbm Putty 1Cc","code_information":[{"code":"02351265","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1438.56,"discounted_cash":719.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reamer","code_information":[{"code":"02351268","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8861.31,"discounted_cash":4430.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125373","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125374","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125375","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125377","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125379","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125380","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125386","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125395","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125396","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_125397","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270_3586781","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351270","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hook Cautery","code_information":[{"code":"02351271","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":701.01,"discounted_cash":350.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation Tactiflex","code_information":[{"code":"02351272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":24850.8,"discounted_cash":12425.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Recharger Percept","code_information":[{"code":"02351274","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":17641.0,"discounted_cash":8820.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Subchondroplasty Total Kit","code_information":[{"code":"02351276","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":26496.9,"discounted_cash":13248.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Ablation","code_information":[{"code":"02351277","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2630","type":"HCPCS"}],"standard_charges":[{"gross_charge":24850.8,"discounted_cash":12425.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Cranial Access","code_information":[{"code":"02351278","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3630.59,"discounted_cash":1815.30,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retrvr Indy Otw","code_information":[{"code":"02351281","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1773","type":"HCPCS"}],"standard_charges":[{"gross_charge":4454.0,"discounted_cash":2227.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dissection Balloon","code_information":[{"code":"02351282","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1917.86,"discounted_cash":958.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Assembly Titan","code_information":[{"code":"02351283","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4950.4,"discounted_cash":2475.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Delivery System","code_information":[{"code":"02351285_128620","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3995.0,"discounted_cash":1997.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Graft Delivery System","code_information":[{"code":"02351285","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3910.0,"discounted_cash":1955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath Powerglide Pro Midline 18-22G","code_information":[{"code":"02351288","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.09,"discounted_cash":454.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microsphere Embolization","code_information":[{"code":"02351290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":7776.0,"discounted_cash":3888.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Dural","code_information":[{"code":"02351292","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":3490.44,"discounted_cash":1745.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Single Lumen Arrowgard","code_information":[{"code":"02351293","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2693.6,"discounted_cash":1346.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nasal Splint","code_information":[{"code":"02351294","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":776.05,"discounted_cash":388.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevalon Seated Positioning Device","code_information":[{"code":"02351295","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":777.0,"discounted_cash":388.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Bizact","code_information":[{"code":"02351301_126572","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ligasure Bizact","code_information":[{"code":"02351301_3584102","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ligasure Bizact","code_information":[{"code":"02351301","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tap","code_information":[{"code":"02351302","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3581.6,"discounted_cash":1790.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Capsular","code_information":[{"code":"02351304","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.31,"discounted_cash":369.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02351306_126675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17912.4,"discounted_cash":8956.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple","code_information":[{"code":"02351306_128485","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17912.4,"discounted_cash":8956.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple","code_information":[{"code":"02351306","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17912.4,"discounted_cash":8956.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spacer Humeral","code_information":[{"code":"02351307","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":61056.0,"discounted_cash":30528.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acessa Ablation","code_information":[{"code":"02351308","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":21535.0,"discounted_cash":10767.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Extender Filler","code_information":[{"code":"02351309","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1602","type":"HCPCS"}],"standard_charges":[{"gross_charge":39200.0,"discounted_cash":19600.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Allograft Cortical Fiber","code_information":[{"code":"02351310","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13120.0,"discounted_cash":6560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Pelvis Triflange","code_information":[{"code":"02351311","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":151040.0,"discounted_cash":75520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cranial Implant","code_information":[{"code":"02351313","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":74083.4,"discounted_cash":37041.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cellular Bone Matrix 1.0Cc","code_information":[{"code":"02351314","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5593.0,"discounted_cash":2796.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Biological Tissue","code_information":[{"code":"02351316","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":15040.0,"discounted_cash":7520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ipg Neurostim","code_information":[{"code":"02351323","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":1887.0,"discounted_cash":943.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inceptiv Pulse Generator Kit","code_information":[{"code":"02351324","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1820","type":"HCPCS"}],"standard_charges":[{"gross_charge":100000.0,"discounted_cash":50000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Neurostimulator Inceptive Recharger","code_information":[{"code":"02351325","type":"CDM"},{"code":"274","type":"RC"},{"code":"L8689","type":"HCPCS"}],"standard_charges":[{"gross_charge":11481.6,"discounted_cash":5740.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Havester","code_information":[{"code":"02351330","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5198.53,"discounted_cash":2599.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Xfit Rod","code_information":[{"code":"02351331","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3529.28,"discounted_cash":1764.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02351332","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":28561.9,"discounted_cash":14280.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Substitute","code_information":[{"code":"02351333","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.0,"discounted_cash":1831.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Dual-Lumen Catheter Polyurethane","code_information":[{"code":"02351335","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":667.25,"discounted_cash":333.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cutting Guide","code_information":[{"code":"02351336","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15930.0,"discounted_cash":7965.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Davinci","code_information":[{"code":"02351337","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":494.55,"discounted_cash":247.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valve Aortic","code_information":[{"code":"02351338","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":160000.0,"discounted_cash":80000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pico Dressing System All Sizes","code_information":[{"code":"02351340_120315","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2434.6,"discounted_cash":1217.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pico Dressing System All Sizes","code_information":[{"code":"02351340_120658","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2434.6,"discounted_cash":1217.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Pico Dressing System All Sizes","code_information":[{"code":"02351340","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2434.6,"discounted_cash":1217.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sleeve Smith 40Mm","code_information":[{"code":"02351341","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":598.31,"discounted_cash":299.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Shunt Ventric","code_information":[{"code":"02351342","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1313.13,"discounted_cash":656.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dialation","code_information":[{"code":"02351344","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1725","type":"HCPCS"}],"standard_charges":[{"gross_charge":27730.0,"discounted_cash":13865.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Steerable","code_information":[{"code":"02351345","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1766","type":"HCPCS"}],"standard_charges":[{"gross_charge":5882.0,"discounted_cash":2941.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cyclone Sinonasal Suction Irrigation","code_information":[{"code":"02351346_127324","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2270.25,"discounted_cash":1135.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cyclone Sinonasal Suction Irrigation","code_information":[{"code":"02351346","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2270.25,"discounted_cash":1135.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue Fascia","code_information":[{"code":"02351347","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1762","type":"HCPCS"}],"standard_charges":[{"gross_charge":5263.2,"discounted_cash":2631.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Harvester","code_information":[{"code":"02351348","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":16261.88,"discounted_cash":8130.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead, Aicd, Endo Single Coil","code_information":[{"code":"02351349","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1777","type":"HCPCS"}],"standard_charges":[{"gross_charge":20060.0,"discounted_cash":10030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Juggerstich","code_information":[{"code":"02351350","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":2874.9,"discounted_cash":1437.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Opra Implant Fixture","code_information":[{"code":"02351351","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":55650.0,"discounted_cash":27825.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Opra Implant Fixture Support","code_information":[{"code":"02351352","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9600.0,"discounted_cash":4800.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Talus Tissue Graft","code_information":[{"code":"02351353","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":38360.0,"discounted_cash":19180.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple Quick Interaxis","code_information":[{"code":"02351354_127421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.8,"discounted_cash":506.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple Quick Interaxis","code_information":[{"code":"02351354","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1013.8,"discounted_cash":506.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Void Filler","code_information":[{"code":"02351355","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":21063.0,"discounted_cash":10531.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mat Silicone Bead","code_information":[{"code":"02351356","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1998.0,"discounted_cash":999.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toe Implant","code_information":[{"code":"02351358","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":28561.9,"discounted_cash":14280.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Overtube Apollo Access","code_information":[{"code":"02351359","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":771.92,"discounted_cash":385.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nasal Stent","code_information":[{"code":"02351361_127532","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6886.4,"discounted_cash":3443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nasal Stent","code_information":[{"code":"02351361","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2625","type":"HCPCS"}],"standard_charges":[{"gross_charge":6886.4,"discounted_cash":3443.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Expander Tissue 50Cc Rectrangle Smooth","code_information":[{"code":"02351362","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6976.0,"discounted_cash":3488.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Graft Delivery System","code_information":[{"code":"02351363","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3492.8,"discounted_cash":1746.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Serfas","code_information":[{"code":"02351364","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1036.0,"discounted_cash":518.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Implant - Left Trabeculink","code_information":[{"code":"02351365","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":175000.0,"discounted_cash":87500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Galaflex","code_information":[{"code":"02351368","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":16520.0,"discounted_cash":8260.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acetabular Ring","code_information":[{"code":"02351369","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":29013.25,"discounted_cash":14506.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acetabular Sizer","code_information":[{"code":"02351370","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2649.2,"discounted_cash":1324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Maxillofacial Splint Temp","code_information":[{"code":"02351372","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":6800.0,"discounted_cash":3400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Maxillofacial Splint","code_information":[{"code":"02351373","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":8640.0,"discounted_cash":4320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vein Harvester","code_information":[{"code":"02351374","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":7358.34,"discounted_cash":3679.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spacer Mold, Cement Bone Stageone","code_information":[{"code":"02351375","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11417.6,"discounted_cash":5708.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Post External Fixation","code_information":[{"code":"02351376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2286.6,"discounted_cash":1143.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02351377_130348","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Staple","code_information":[{"code":"02351377","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7040.0,"discounted_cash":3520.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Balloon  Hurricane","code_information":[{"code":"02351378","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":20060.0,"discounted_cash":10030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reflector Scout","code_information":[{"code":"02351380","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Tapestry Bointegrative","code_information":[{"code":"02351382","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13888.0,"discounted_cash":6944.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Driver Battery","code_information":[{"code":"02351383","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3529.8,"discounted_cash":1764.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrosurgical Isolator","code_information":[{"code":"02351384","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":30240.0,"discounted_cash":15120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Wedge Allosync","code_information":[{"code":"02351385","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10560.0,"discounted_cash":5280.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilatation","code_information":[{"code":"02351386","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":20060.0,"discounted_cash":10030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Da Vinci Firefly Fluorseence","code_information":[{"code":"02351388","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1515.77,"discounted_cash":757.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_127923","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_127927","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128543","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128544","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128546","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":4965.0,"discounted_cash":2482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128667","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128840","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":4965.0,"discounted_cash":2482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_128841","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":4965.0,"discounted_cash":2482.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_129133","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_129808","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_129810","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_129812","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389_129813","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Iol Presbyopia Correcting","code_information":[{"code":"02351389","type":"CDM"},{"code":"276","type":"RC"},{"code":"V2788","type":"HCPCS"}],"standard_charges":[{"gross_charge":6496.0,"discounted_cash":3248.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Port Illuminator Mars","code_information":[{"code":"02351392","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15884.8,"discounted_cash":7942.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Multi Trach Tube","code_information":[{"code":"02351395","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4208.52,"discounted_cash":2104.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Dilatation","code_information":[{"code":"02351397","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2623","type":"HCPCS"}],"standard_charges":[{"gross_charge":31640.0,"discounted_cash":15820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue Neox","code_information":[{"code":"02351398_128091","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4148","type":"HCPCS"}],"standard_charges":[{"gross_charge":14048.0,"discounted_cash":7024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Soft Tissue Neox","code_information":[{"code":"02351398","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4148","type":"HCPCS"}],"standard_charges":[{"gross_charge":14048.0,"discounted_cash":7024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02351400","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":6697.6,"discounted_cash":3348.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Cage","code_information":[{"code":"02351401","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":785.0,"discounted_cash":392.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Graft","code_information":[{"code":"02351402","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11513.6,"discounted_cash":5756.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Curette","code_information":[{"code":"02351403_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Curette","code_information":[{"code":"02351403","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Cement Kit","code_information":[{"code":"02351404_128207","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14868.16,"discounted_cash":7434.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cement Kit","code_information":[{"code":"02351404_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14868.16,"discounted_cash":7434.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cement Kit","code_information":[{"code":"02351404_3584539","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14868.16,"discounted_cash":7434.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Cement Kit","code_information":[{"code":"02351404","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14868.16,"discounted_cash":7434.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrosurgical Debrider","code_information":[{"code":"02351406","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5610.0,"discounted_cash":2805.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue Neox","code_information":[{"code":"02351407_128231","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4148","type":"HCPCS"}],"standard_charges":[{"gross_charge":16225.0,"discounted_cash":8112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Soft Tissue Neox","code_information":[{"code":"02351407","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4148","type":"HCPCS"}],"standard_charges":[{"gross_charge":16225.0,"discounted_cash":8112.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transtibial Acl Kit","code_information":[{"code":"02351408_128235","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Transtibial Acl Kit","code_information":[{"code":"02351408","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1073.0,"discounted_cash":536.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Patellofemoral Template","code_information":[{"code":"02351409_128255","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":1461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Patellofemoral Template","code_information":[{"code":"02351409","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2923.0,"discounted_cash":1461.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mandrecon Antguide","code_information":[{"code":"02351410","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":22538.0,"discounted_cash":11269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accumodel Maxilla","code_information":[{"code":"02351411","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":25960.0,"discounted_cash":12980.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Embolization Protective System","code_information":[{"code":"02351413","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1884","type":"HCPCS"}],"standard_charges":[{"gross_charge":23594.1,"discounted_cash":11797.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sling Traction","code_information":[{"code":"02351414","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Hip Right Trabeculink","code_information":[{"code":"02351415","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":280000.0,"discounted_cash":140000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mandible Reconstruction Guide","code_information":[{"code":"02351416","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":125000.0,"discounted_cash":62500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vest Compression 3Xl","code_information":[{"code":"02351417","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1043.4,"discounted_cash":521.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Neg Pressure Pump 7 Day","code_information":[{"code":"02351419","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2331.0,"discounted_cash":1165.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pump Intrathecal","code_information":[{"code":"02351421","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1772","type":"HCPCS"}],"standard_charges":[{"gross_charge":66409.0,"discounted_cash":33204.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Mapping Sensor","code_information":[{"code":"02351422","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1730","type":"HCPCS"}],"standard_charges":[{"gross_charge":15340.0,"discounted_cash":7670.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Marrow Aspiration Kit","code_information":[{"code":"02351425_128376","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6242.4,"discounted_cash":3121.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Bone Marrow Aspiration Kit","code_information":[{"code":"02351425","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6242.4,"discounted_cash":3121.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Balloon Cervica","code_information":[{"code":"02351426","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.05,"discounted_cash":229.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Biobrush Wound Irrigation","code_information":[{"code":"02351427","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tray Picc 5Fr Triple Lumen 3Cg Tip","code_information":[{"code":"02351431_C1751_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":7490.36,"discounted_cash":3745.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tray Picc 5Fr Triple Lumen 3Cg Tip","code_information":[{"code":"02351431","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":7490.35,"discounted_cash":3745.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Cath Single Lumen 4Fr 55Cm","code_information":[{"code":"02351432_C1751_272","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1897.14,"discounted_cash":948.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Picc Cath Single Lumen 4Fr 55Cm","code_information":[{"code":"02351432","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1897.14,"discounted_cash":948.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Contour Sizer","code_information":[{"code":"02351433","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2649.2,"discounted_cash":1324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transducer Hemodynamic Triple","code_information":[{"code":"02351434","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":439.36,"discounted_cash":219.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Curette","code_information":[{"code":"02351435","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5768.1,"discounted_cash":2884.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluidics Mnmgt Intrepid","code_information":[{"code":"02351437_126623","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":779.98,"discounted_cash":389.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Fluidics Mnmgt Intrepid","code_information":[{"code":"02351437","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":779.98,"discounted_cash":389.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ring Hip Ancetabular","code_information":[{"code":"02351439","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":29013.25,"discounted_cash":14506.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bactisure Lavage","code_information":[{"code":"02351440","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":4624.0,"discounted_cash":2312.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Graft Thoracic","code_information":[{"code":"02351448","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":160000.0,"discounted_cash":80000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit","code_information":[{"code":"02351453","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":11604.16,"discounted_cash":5802.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Algraft Acellular Dermal Matrix Meshed","code_information":[{"code":"02351454","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19529.0,"discounted_cash":9764.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Screw","code_information":[{"code":"02351455","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":56000.0,"discounted_cash":28000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Omni Translumal Delivery","code_information":[{"code":"02351457_128679","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10233.6,"discounted_cash":5116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Omni Translumal Delivery","code_information":[{"code":"02351457","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10233.6,"discounted_cash":5116.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alloaid Subchon Sizer Kit","code_information":[{"code":"02351458","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3434.0,"discounted_cash":1717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Positioning Device Operative","code_information":[{"code":"02351460_101115","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":865.8,"discounted_cash":432.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Positioning Device Operative","code_information":[{"code":"02351460","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":865.8,"discounted_cash":432.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Emg 18 Mm 2 Channel","code_information":[{"code":"02351466_42814","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":901.84,"discounted_cash":450.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrode Emg 18 Mm 2 Channel","code_information":[{"code":"02351466","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":901.84,"discounted_cash":450.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Emg 18Mm Press Paired 2 Chan","code_information":[{"code":"02351467_111277","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1160.32,"discounted_cash":580.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Electrode Emg 18Mm Press Paired 2 Chan","code_information":[{"code":"02351467","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1160.32,"discounted_cash":580.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351468","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":5401.04,"discounted_cash":2700.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351472","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":7442.75,"discounted_cash":3721.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351474","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":9005.89,"discounted_cash":4502.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351478","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13185.79,"discounted_cash":6592.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351479","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14504.45,"discounted_cash":7252.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351480","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":15955.01,"discounted_cash":7977.50,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351483","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":19577.2,"discounted_cash":9788.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Elbow Joint Implant","code_information":[{"code":"02351484","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21535.0,"discounted_cash":10767.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351506","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3374.25,"discounted_cash":1687.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351507","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3410.81,"discounted_cash":1705.40,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351508","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":3751.97,"discounted_cash":1875.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351510","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":4540.02,"discounted_cash":2270.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351513","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":6042.96,"discounted_cash":3021.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351522","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":13411.65,"discounted_cash":6705.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351523","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14752.9,"discounted_cash":7376.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351524","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":14960.39,"discounted_cash":7480.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351528","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":21903.81,"discounted_cash":10951.90,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351530","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":26503.74,"discounted_cash":13251.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ankle Joint Implant","code_information":[{"code":"02351533","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":33482.96,"discounted_cash":16741.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351544","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.0,"discounted_cash":314.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351546","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.04,"discounted_cash":380.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351547","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":788.17,"discounted_cash":394.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351550_16878","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351550_36139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351550_73131","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351550_86550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351550","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.32,"discounted_cash":524.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351551","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1154.33,"discounted_cash":577.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351552_23788","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.84,"discounted_cash":634.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351552","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1269.84,"discounted_cash":634.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351554_86290","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.68,"discounted_cash":768.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351554","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1536.68,"discounted_cash":768.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555_112503","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555_112515","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555_128431","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555_128432","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555_71143","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351555","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1690.38,"discounted_cash":845.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351556","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":1859.55,"discounted_cash":929.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351557_113638","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.58,"discounted_cash":1022.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351557_114123","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.58,"discounted_cash":1022.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351557","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2045.58,"discounted_cash":1022.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351560_76711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.9,"discounted_cash":1361.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351560","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.9,"discounted_cash":1361.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351561","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":2995.22,"discounted_cash":1497.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351562_76712","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.85,"discounted_cash":1647.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351562","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3294.85,"discounted_cash":1647.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351564","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":3663.64,"discounted_cash":1831.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351565_112570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4030.09,"discounted_cash":2015.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351565_76713","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4030.09,"discounted_cash":2015.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351565","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4030.09,"discounted_cash":2015.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351566_103948","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4433.19,"discounted_cash":2216.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351566","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4433.19,"discounted_cash":2216.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351567","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4876.55,"discounted_cash":2438.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351568","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":5364.25,"discounted_cash":2682.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351570_103749","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6490.94,"discounted_cash":3245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351570","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6490.94,"discounted_cash":3245.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351571_76940","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.06,"discounted_cash":3360.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351571","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":6720.06,"discounted_cash":3360.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351572_105275","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":7392.13,"discounted_cash":3696.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351572","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":7392.13,"discounted_cash":3696.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351574","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":8944.64,"discounted_cash":4472.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351575","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":9839.17,"discounted_cash":4919.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351577","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":11905.47,"discounted_cash":5952.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh Implant","code_information":[{"code":"02351583","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":19444.04,"discounted_cash":9722.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Standard Maquet","code_information":[{"code":"02351598","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":591.34,"discounted_cash":295.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Light Source Illumination System","code_information":[{"code":"02351601","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5623.6,"discounted_cash":2811.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent, Non-Coa/Non-Cov W/Del","code_information":[{"code":"02351603","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":12000.0,"discounted_cash":6000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mesh For Sacrocolpopexy","code_information":[{"code":"02351605","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1763","type":"HCPCS"}],"standard_charges":[{"gross_charge":6047.65,"discounted_cash":3023.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351606","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3478.0,"discounted_cash":1739.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Spacer","code_information":[{"code":"02351609","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":30991.6,"discounted_cash":15495.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surface Electrodes Ensite","code_information":[{"code":"02351613","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6720.0,"discounted_cash":3360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113950","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113952","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113955","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113956","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113959","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113960","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113966","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113967","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113968","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113973","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113974","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113976","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113980","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113982","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113995","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_113997","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_3583949","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_3583958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_3583964","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351614_3583965","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent, Coated/Cov W/Del Sys","code_information":[{"code":"02351619","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":19983.3,"discounted_cash":9991.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Electrosurgical","code_information":[{"code":"02351621","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1753.8,"discounted_cash":876.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Vascular","code_information":[{"code":"02351622","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1768","type":"HCPCS"}],"standard_charges":[{"gross_charge":6514.4,"discounted_cash":3257.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Thermodilution Swan Ganz","code_information":[{"code":"02351623","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":895.4,"discounted_cash":447.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Skin Flexhd Pliable 16 X 20 Cm","code_information":[{"code":"02351624","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4128","type":"HCPCS"}],"standard_charges":[{"gross_charge":46816.28,"discounted_cash":23408.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Triple Lumen 7F X 20 Cm Agb","code_information":[{"code":"02351625","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":1075.96,"discounted_cash":537.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Accessory Kit Plug","code_information":[{"code":"02351632","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2449.4,"discounted_cash":1224.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Guiding","code_information":[{"code":"02351636","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1887","type":"HCPCS"}],"standard_charges":[{"gross_charge":18850.5,"discounted_cash":9425.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manipulator Uterine","code_information":[{"code":"02351638_127121","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":616.55,"discounted_cash":308.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Manipulator Uterine","code_information":[{"code":"02351638","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":616.55,"discounted_cash":308.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dressing System Pico 7","code_information":[{"code":"02351639","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1790.8,"discounted_cash":895.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Scissors Ensizor","code_information":[{"code":"02351640","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2701.0,"discounted_cash":1350.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prevena Restore 21Cm & 24 Cm","code_information":[{"code":"02351641","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5780.0,"discounted_cash":2890.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cath, Bal Dil, Non-Vascular","code_information":[{"code":"02351643","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1726","type":"HCPCS"}],"standard_charges":[{"gross_charge":14080.0,"discounted_cash":7040.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Plasmabutton","code_information":[{"code":"02351644","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3525.8,"discounted_cash":1762.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Access Instrument Intracept","code_information":[{"code":"02351645","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":15360.0,"discounted_cash":7680.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Delineator Advincula Ultem","code_information":[{"code":"02351646","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":888.1,"discounted_cash":444.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Bone Infuse Rhbmp","code_information":[{"code":"02351647","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":33096.0,"discounted_cash":16548.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Internal Knee Ligament Augmentation","code_information":[{"code":"02351649_95919","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7648.0,"discounted_cash":3824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Internal Knee Ligament Augmentation","code_information":[{"code":"02351649","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":7648.0,"discounted_cash":3824.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fiducial Marker Gold 18G 20Cm 1 Needle","code_information":[{"code":"02351651","type":"CDM"},{"code":"278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":2738.0,"discounted_cash":1369.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple","code_information":[{"code":"02351659","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":13408.0,"discounted_cash":6704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Knee Femoral","code_information":[{"code":"02351660","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":1457.8,"discounted_cash":728.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Probe Digitimer","code_information":[{"code":"02351661","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1069.3,"discounted_cash":534.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Harvester","code_information":[{"code":"02351662_128755","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Harvester","code_information":[{"code":"02351662","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6460.0,"discounted_cash":3230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Vac Harvesting Filter","code_information":[{"code":"02351663","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2397.9,"discounted_cash":1198.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipografter  Autologus","code_information":[{"code":"02351665","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2630.7,"discounted_cash":1315.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lymphatic Magtrace","code_information":[{"code":"02351667","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9697","type":"HCPCS"}],"standard_charges":[{"gross_charge":4751.43,"discounted_cash":2375.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Spreader","code_information":[{"code":"02351668_128044","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Graft Spreader","code_information":[{"code":"02351668","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2775.0,"discounted_cash":1387.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Penile Prosthesis","code_information":[{"code":"02351669","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1813","type":"HCPCS"}],"standard_charges":[{"gross_charge":77090.51,"discounted_cash":38545.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glenoid Calibrator","code_information":[{"code":"02351670_128799","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Glenoid Calibrator","code_information":[{"code":"02351670","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1850.0,"discounted_cash":925.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glenoid Model 3D","code_information":[{"code":"02351671_128800","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Glenoid Model 3D","code_information":[{"code":"02351671","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3700.0,"discounted_cash":1850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Pelvis","code_information":[{"code":"02351673","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":132066.0,"discounted_cash":66033.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ureteroscope Flexible Axis","code_information":[{"code":"02351674_129115","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Ureteroscope Flexible Axis","code_information":[{"code":"02351674","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1747","type":"HCPCS"}],"standard_charges":[{"gross_charge":7680.0,"discounted_cash":3840.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02351675_129117","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.15,"discounted_cash":231.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02351675_129425","type":"CDM"},{"code":"272","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.15,"discounted_cash":231.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Stent Ureteral","code_information":[{"code":"02351675","type":"CDM"},{"code":"278","type":"RC"},{"code":"C2617","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.15,"discounted_cash":231.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Puraply Mz 1000Mg","code_information":[{"code":"02351676","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":13337.6,"discounted_cash":6668.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Back Plate","code_information":[{"code":"02351677","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":30072.68,"discounted_cash":15036.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Spinal Fixation Ifuse","code_information":[{"code":"02351680","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1737","type":"HCPCS"}],"standard_charges":[{"gross_charge":16060.0,"discounted_cash":8030.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wedge Augmentation Titan","code_information":[{"code":"02351682","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13328.0,"discounted_cash":6664.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Matrix Tissue Paraderm Thk1 Mm","code_information":[{"code":"02351683","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":16829.75,"discounted_cash":8414.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Soft Tissue Pro3","code_information":[{"code":"02351684","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4100","type":"HCPCS"}],"standard_charges":[{"gross_charge":23157.5,"discounted_cash":11578.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannula Opthalmic Streamline","code_information":[{"code":"02351685_129269","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Cannula Opthalmic Streamline","code_information":[{"code":"02351685","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":10240.0,"discounted_cash":5120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tensioner Surgical Cerclage","code_information":[{"code":"02351691_129316","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tensioner Surgical Cerclage","code_information":[{"code":"02351691","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2035.0,"discounted_cash":1017.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Closure Device","code_information":[{"code":"02351694","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":11193.6,"discounted_cash":5596.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter 10Fr Gyrus","code_information":[{"code":"02351695_129422","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Catheter 10Fr Gyrus","code_information":[{"code":"02351695","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1295.0,"discounted_cash":647.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lazer Filter","code_information":[{"code":"02351696_129423","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3095.64,"discounted_cash":1547.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Lazer Filter","code_information":[{"code":"02351696","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3095.64,"discounted_cash":1547.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Icast Covered System","code_information":[{"code":"02351697","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1874","type":"HCPCS"}],"standard_charges":[{"gross_charge":18414.49,"discounted_cash":9207.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catheter Femoral Venous","code_information":[{"code":"02351698","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3570.0,"discounted_cash":1785.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Collector Specimen Graftnet","code_information":[{"code":"02351701_129481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Collector Specimen Graftnet","code_information":[{"code":"02351701","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Instrument Orthopedic Activation Tool","code_information":[{"code":"02351702_129489","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Instrument Orthopedic Activation Tool","code_information":[{"code":"02351702","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":925.0,"discounted_cash":462.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Iliac Self-Expanding","code_information":[{"code":"02351703","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":7865.54,"discounted_cash":3932.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sheath Introducer","code_information":[{"code":"02351704","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1894","type":"HCPCS"}],"standard_charges":[{"gross_charge":1568.8,"discounted_cash":784.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrode Aliya","code_information":[{"code":"02351705","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":52640.0,"discounted_cash":26320.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tap Cannulated","code_information":[{"code":"02351706_129642","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Tap Cannulated","code_information":[{"code":"02351706","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2812.0,"discounted_cash":1406.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Picc Triple Luman Arrowgard","code_information":[{"code":"02351707","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2890.93,"discounted_cash":1445.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mica Solo Guide Prostep Mic Sterile","code_information":[{"code":"02351708","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5950.0,"discounted_cash":2975.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Spinal Mas Light Cable","code_information":[{"code":"02351710","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2960.0,"discounted_cash":1480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Spacer","code_information":[{"code":"02351711","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":2368.0,"discounted_cash":1184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Putty","code_information":[{"code":"02351715","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":5100.0,"discounted_cash":2550.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Putty","code_information":[{"code":"02351716","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":13747.2,"discounted_cash":6873.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nebulizer Aeroneb","code_information":[{"code":"02351717_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":401.13,"discounted_cash":200.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nebulizer Aeroneb","code_information":[{"code":"02351717","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":401.13,"discounted_cash":200.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Graft Bioskin Amniotic Membrane","code_information":[{"code":"02351718","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4163","type":"HCPCS"}],"standard_charges":[{"gross_charge":6283.2,"discounted_cash":3141.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rod Intramedullary","code_information":[{"code":"02351719","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":17717.7,"discounted_cash":8858.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blade Surgical Exodus","code_information":[{"code":"02351720","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":14860.8,"discounted_cash":7430.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Atlas Pro Drive Battery Pack","code_information":[{"code":"02351721","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3122.8,"discounted_cash":1561.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coil","code_information":[{"code":"02351726","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9088.0,"discounted_cash":4544.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Totak Knee System","code_information":[{"code":"02351728","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":88168.2,"discounted_cash":44084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pectus Bar Implant","code_information":[{"code":"02351729","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":29382.0,"discounted_cash":14691.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pectus Bar Stabilizer","code_information":[{"code":"02351730","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":19352.0,"discounted_cash":9676.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bariatric Sling","code_information":[{"code":"02351731","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":493.77,"discounted_cash":246.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture Tape","code_information":[{"code":"02351732","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2760.0,"discounted_cash":1380.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Limb Positioning","code_information":[{"code":"02351733_130481","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Limb Positioning","code_information":[{"code":"02351733","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":471.0,"discounted_cash":235.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flexband Spacer","code_information":[{"code":"02351734_130484","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9255.04,"discounted_cash":4627.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Flexband Spacer","code_information":[{"code":"02351734","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":9255.04,"discounted_cash":4627.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Interlaminar Stabilization","code_information":[{"code":"02351736_130614","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":48720.0,"discounted_cash":24360.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Spinal Interlaminar Stabilization","code_information":[{"code":"02351736","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1821","type":"HCPCS"}],"standard_charges":[{"gross_charge":34800.0,"discounted_cash":17400.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staple Nitinol","code_information":[{"code":"02351737","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":1590.5,"discounted_cash":795.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Total Knee","code_information":[{"code":"02351738","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":88168.2,"discounted_cash":44084.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"02351743_130724","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":19906.6,"discounted_cash":9953.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Forceps Bipolar","code_information":[{"code":"02351755","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2597.4,"discounted_cash":1298.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc System Flowsafe Cpap","code_information":[{"code":"02351756","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.73,"discounted_cash":284.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stent Vas Retrievable","code_information":[{"code":"02351757","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1876","type":"HCPCS"}],"standard_charges":[{"gross_charge":23570.5,"discounted_cash":11785.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hip Contour Sizer","code_information":[{"code":"02351758","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2649.2,"discounted_cash":1324.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Custom Hip Ion Implant","code_information":[{"code":"02351759","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1776","type":"HCPCS"}],"standard_charges":[{"gross_charge":24000.0,"discounted_cash":12000.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drill Bit Constrictor Rope","code_information":[{"code":"02351760","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":17682.3,"discounted_cash":8841.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pad Grounding","code_information":[{"code":"02351761","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":473.83,"discounted_cash":236.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Micro Tip Handpiece","code_information":[{"code":"02351762","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":5746.0,"discounted_cash":2873.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Marker Implanter Stylet","code_information":[{"code":"02351763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":6766.0,"discounted_cash":3383.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Da Vinci Firefly Fluorseence","code_information":[{"code":"02351764","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1087.58,"discounted_cash":543.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail","code_information":[{"code":"02351765","type":"CDM"},{"code":"272","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":64130.0,"discounted_cash":32065.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemostatic Powder","code_information":[{"code":"02351766","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1258.0,"discounted_cash":629.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Positioning Mask Head","code_information":[{"code":"02351767","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1441.15,"discounted_cash":720.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc V Vacuum Stabilizer","code_information":[{"code":"02351768","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":8704.58,"discounted_cash":4352.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mask Pft","code_information":[{"code":"02351769","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":474.93,"discounted_cash":237.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vizadisc Knee Procedure Mako","code_information":[{"code":"02351770","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1215.45,"discounted_cash":607.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Checkpointmako St","code_information":[{"code":"02351771","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":568.73,"discounted_cash":284.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clip Irrigation Mako","code_information":[{"code":"02351772","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":678.24,"discounted_cash":339.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Vizadisc Hip Procedure","code_information":[{"code":"02351773","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1215.45,"discounted_cash":607.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Checkpoint 3.5Mm Hex Impaction","code_information":[{"code":"02351774","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":660.58,"discounted_cash":330.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Localizer Surgical Probe","code_information":[{"code":"02351775","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":411.34,"discounted_cash":205.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snare Suction","code_information":[{"code":"02351776","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1605.87,"discounted_cash":802.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gopap Mask","code_information":[{"code":"02351777","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":469.19,"discounted_cash":234.60,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kit Cricothyrotomy","code_information":[{"code":"02351778","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":1492.36,"discounted_cash":746.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allograft Amniotic Membrane 3","code_information":[{"code":"02351779","type":"CDM"},{"code":"278","type":"RC"},{"code":"Q4150","type":"HCPCS"}],"standard_charges":[{"gross_charge":27374.82,"discounted_cash":13687.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nail Sleeve","code_information":[{"code":"02351780","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2231.1,"discounted_cash":1115.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Applicator Endoclot","code_information":[{"code":"02351781","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":463.25,"discounted_cash":231.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cage Llif Patient Specific","code_information":[{"code":"02351782","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1831","type":"HCPCS"}],"standard_charges":[{"gross_charge":89700.0,"discounted_cash":44850.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Washer Orthopedic","code_information":[{"code":"02351783","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":999.0,"discounted_cash":499.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Custom Joint W/O Con Rt","code_information":[{"code":"02573721","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"04163061_36139","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1781","type":"HCPCS"}],"standard_charges":[{"gross_charge":4420.0,"discounted_cash":2210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Nutrition Therapy Initl/15 Min","code_information":[{"code":"04307802","type":"CDM"},{"code":"942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.0,"discounted_cash":32.5,"setting":"both","modifiers":"33","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 33: Preventive Services"}]},{"description":"Hc Nutrition Therapy Subsq/15 Min","code_information":[{"code":"04307803","type":"CDM"},{"code":"942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":28.0,"setting":"both","modifiers":"33","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 33: Preventive Services"}]},{"description":"Hc Isolation Contact","code_information":[{"code":"06078000_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":84.76,"discounted_cash":42.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Contact","code_information":[{"code":"06078000","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Droplet","code_information":[{"code":"06078001_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Droplet","code_information":[{"code":"06078001","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Droplet & Contact","code_information":[{"code":"06078002_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":210.41,"discounted_cash":105.20,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Droplet & Contact","code_information":[{"code":"06078002","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Airborne W/Hepa","code_information":[{"code":"06078003_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Airborne W/Hepa","code_information":[{"code":"06078003","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Airborne & Contact","code_information":[{"code":"06078004_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Airborne & Contact","code_information":[{"code":"06078004","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Enhanced Contact","code_information":[{"code":"06078005_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Enhanced Contact","code_information":[{"code":"06078005","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":88.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Airborne & Enhanced Contact","code_information":[{"code":"06078006","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Airborne & Enhanced Contact","code_information":[{"code":"06078006_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Droplet & Enhanced Contact","code_information":[{"code":"06078007_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Droplet & Enhanced Contact","code_information":[{"code":"06078007","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Isolation Contact, Airborne & Droplet","code_information":[{"code":"06078010_272","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Isolation Contact, Airborne & Droplet","code_information":[{"code":"06078010","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":219.0,"discounted_cash":109.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ind Psych 30Min","code_information":[{"code":"06477777","type":"CDM"},{"code":"914","type":"RC"},{"code":"90832","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ind Psych 45Min","code_information":[{"code":"06477778","type":"CDM"},{"code":"914","type":"RC"},{"code":"90834","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ind Psych 60Min","code_information":[{"code":"06477779","type":"CDM"},{"code":"914","type":"RC"},{"code":"90837","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ind Psych Eval","code_information":[{"code":"06477782","type":"CDM"},{"code":"914","type":"RC"},{"code":"90791","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol &/Or Sub Abs>30Mn","code_information":[{"code":"06477785","type":"CDM"},{"code":"914","type":"RC"},{"code":"G0397","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypnotherapy","code_information":[{"code":"06477786","type":"CDM"},{"code":"914","type":"RC"},{"code":"90880","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ind Psych Eap","code_information":[{"code":"06477787","type":"CDM"},{"code":"914","type":"RC"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture","code_information":[{"code":"09200155","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":565.2,"discounted_cash":282.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture 7-0 Prolene Bv-1 C.V.","code_information":[{"code":"09200232","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":583.0,"discounted_cash":291.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture 6-0 Prolene C-1 Cv (Ms","code_information":[{"code":"09200234","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":515.25,"discounted_cash":257.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture 2-0 Sh-2 Ethibond Sxx92","code_information":[{"code":"09204753","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":502.87,"discounted_cash":251.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suture 2-0 Ethibond Sh/Pxx86","code_information":[{"code":"09204763","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":468.67,"discounted_cash":234.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laboring Room","code_information":[{"code":"10010025","type":"CDM"},{"code":"112","type":"RC"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":1175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Post Partum Room","code_information":[{"code":"10010026","type":"CDM"},{"code":"112","type":"RC"}],"standard_charges":[{"gross_charge":2350.0,"discounted_cash":1175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Newborn Care","code_information":[{"code":"10010028","type":"CDM"},{"code":"170","type":"RC"}],"standard_charges":[{"gross_charge":1585.0,"discounted_cash":792.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Snf Room","code_information":[{"code":"10010029","type":"CDM"},{"code":"120","type":"RC"}],"standard_charges":[{"gross_charge":2849.0,"discounted_cash":1424.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Progressive Care Room","code_information":[{"code":"10010035","type":"CDM"},{"code":"206","type":"RC"}],"standard_charges":[{"gross_charge":3077.0,"discounted_cash":1538.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acute Care Room","code_information":[{"code":"10010051","type":"CDM"},{"code":"111","type":"RC"}],"standard_charges":[{"gross_charge":2065.0,"discounted_cash":1032.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intensive Care Level 1","code_information":[{"code":"10010052","type":"CDM"},{"code":"200","type":"RC"}],"standard_charges":[{"gross_charge":3803.0,"discounted_cash":1901.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Newborn Level 1","code_information":[{"code":"10010090","type":"CDM"},{"code":"171","type":"RC"}],"standard_charges":[{"gross_charge":1585.0,"discounted_cash":792.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mri-Upper Extremity W/O Con Rt","code_information":[{"code":"11573220","type":"CDM"},{"code":"610","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":3098.0,"discounted_cash":1549.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/O Con Rt","code_information":[{"code":"11573221","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Shoulder W/O Contrast Rt","code_information":[{"code":"11573222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/Wo Con R","code_information":[{"code":"11573223","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Lower Extremity W/Wo Con R","code_information":[{"code":"11573718","type":"CDM"},{"code":"610","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":4841.0,"discounted_cash":2420.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Lower Extremity W/O Con Rt","code_information":[{"code":"11573720","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":3048.0,"discounted_cash":1524.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/O Con Rt","code_information":[{"code":"11573721","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Knee W/O Contrast Rt","code_information":[{"code":"11573722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Upper Extremity W/Wo Con R","code_information":[{"code":"11574220","type":"CDM"},{"code":"610","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":4945.0,"discounted_cash":2472.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Upper Ext Joint W/Con Rt","code_information":[{"code":"11574222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Shoulder W/Wo Contrast Rt","code_information":[{"code":"11574223","type":"CDM"},{"code":"610","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/Con Rt","code_information":[{"code":"11574722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Lower Ext Joint W/Wo Con R","code_information":[{"code":"11574723","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":4994.0,"discounted_cash":2497.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Mri-Shoulder W/Contrast Rt","code_information":[{"code":"11575222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":9940.0,"discounted_cash":4970.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Iliac Revas W/Stent & Pta Init","code_information":[{"code":"11597221","type":"CDM"},{"code":"361","type":"RC"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":32540.0,"discounted_cash":16270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ribs 2 Views Unilateral Rt","code_information":[{"code":"11611100","type":"CDM"},{"code":"320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Ribs Unilat W/Pa Chest R 3+ Views","code_information":[{"code":"11611101","type":"CDM"},{"code":"324","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Thoracic Spine 2 Views","code_information":[{"code":"11612070","type":"CDM"},{"code":"320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":577.0,"discounted_cash":288.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Clavicle Rt","code_information":[{"code":"11613000","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Scapula Rt","code_information":[{"code":"11613010","type":"CDM"},{"code":"320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":349.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Shoulder Single View Rt","code_information":[{"code":"11613020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Shoulder Min 2 Views Rt","code_information":[{"code":"11613031","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Humerus Min 2 Views Rt","code_information":[{"code":"11613060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Elbow Min 3 Views Rt","code_information":[{"code":"11613070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Forearm 2 Views Rt","code_information":[{"code":"11613090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Wrist 2 Views Rt","code_information":[{"code":"11613100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Wrist 3 Views Rt","code_information":[{"code":"11613110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Hand 2 Views Rt","code_information":[{"code":"11613120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":283.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Hand Min 3 Views Rt","code_information":[{"code":"11613130","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Finger 2+ Views Rt","code_information":[{"code":"11613140","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Inj Shoulder Arthrogram Rt","code_information":[{"code":"11613350","type":"CDM"},{"code":"361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":686.0,"discounted_cash":343.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Hip Ap Only Rt","code_information":[{"code":"11613500","type":"CDM"},{"code":"320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray Exam Hip Uni 2-3 Views Rt","code_information":[{"code":"11613510","type":"CDM"},{"code":"320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Femur 2 Views Rt","code_information":[{"code":"11613550","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Femur 1 View Rt","code_information":[{"code":"11613551","type":"CDM"},{"code":"320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Knee Two Views Rt","code_information":[{"code":"11613560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Knee - 4 Vws Or More Rt","code_information":[{"code":"11613564","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Knee Three Views Rt","code_information":[{"code":"11613581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Tibia-Fibula 2 Views Rt","code_information":[{"code":"11613590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Ankle 2 Views Rt","code_information":[{"code":"11613600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Ankle Min 3 Views Rt","code_information":[{"code":"11613610","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Foot 1 View Rt","code_information":[{"code":"11613620","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Foot 3 Or More Views Rt","code_information":[{"code":"11613630","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Foot 2 Views Rt","code_information":[{"code":"11613631","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Oscalcis (Heel) 2+ Views Rt","code_information":[{"code":"11613650","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Toe 2+ Views Rt","code_information":[{"code":"11613660","type":"CDM"},{"code":"320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Wrist W/Carpal Series Rt","code_information":[{"code":"11614110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Inj Elbow Arthrogram Rt","code_information":[{"code":"11614229","type":"CDM"},{"code":"361","type":"RC"},{"code":"24220","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Ankle 1 View Rt","code_information":[{"code":"11614600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":411.0,"discounted_cash":205.5,"setting":"both","modifiers":"RT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Wrist 1 View Rt","code_information":[{"code":"11615100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"RT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Hand 1 View Rt","code_information":[{"code":"11615120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":566.0,"discounted_cash":283.0,"setting":"both","modifiers":"RT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc Inj Wrist Arthrogram Rt","code_information":[{"code":"11615246","type":"CDM"},{"code":"361","type":"RC"},{"code":"25246","type":"HCPCS"}],"standard_charges":[{"gross_charge":879.0,"discounted_cash":439.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Angio-Extremities-Unilateral R","code_information":[{"code":"11615712","type":"CDM"},{"code":"320","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":9858.0,"discounted_cash":4929.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Inj Hip Arthrogram Rt","code_information":[{"code":"11617093","type":"CDM"},{"code":"361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":997.0,"discounted_cash":498.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray Exam Of Forearm 2 Views Rt Ltd","code_information":[{"code":"11618033","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","modifiers":"RT|52","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body) | Modifier 52: Reduced Services"}]},{"description":"Hc X-Ray-Knee Single View Rt","code_information":[{"code":"11618560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc X-Ray-Elbow 2 Views Rt","code_information":[{"code":"11619070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.0,"discounted_cash":249.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc U/S Extr Non-Vasc Lmtd Rt","code_information":[{"code":"11646880","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.0,"discounted_cash":594.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ct Upper Ext W/O Contrast Rt","code_information":[{"code":"11663200","type":"CDM"},{"code":"352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1560.0,"discounted_cash":780.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ct Upper Ext W/Contrast Rt","code_information":[{"code":"11663201","type":"CDM"},{"code":"352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4833.0,"discounted_cash":2416.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Cta-Upper Extremity Right","code_information":[{"code":"11663206","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2569.0,"discounted_cash":1284.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ct Lower Ext W/O Contrast Rt","code_information":[{"code":"11663700","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1317.0,"discounted_cash":658.5,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ct Lower Ext W/Contrast Rt","code_information":[{"code":"11663701","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":2460.0,"discounted_cash":1230.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ct Lower Ext W/Wo Contrast Rt","code_information":[{"code":"11663702","type":"CDM"},{"code":"352","type":"RC"},{"code":"73702","type":"HCPCS"}],"standard_charges":[{"gross_charge":2952.0,"discounted_cash":1476.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Cta-Lower Extremity Right","code_information":[{"code":"11663706","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":3186.0,"discounted_cash":1593.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Splint; Finger L 2 Static-Ot","code_information":[{"code":"11738072","type":"CDM"},{"code":"430","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":357.0,"discounted_cash":178.5,"setting":"both","modifiers":"GO|F1","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier GO: Services delivered under an outpatient occupational therapy plan of care | Modifier F1: Left hand, second digit"}]},{"description":"Hc Unna Boot Strapping - Lt","code_information":[{"code":"11899580","type":"CDM"},{"code":"761","type":"RC"},{"code":"29580","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":195.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Multlay Comprs Lwr Leg- Lt","code_information":[{"code":"11899581","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.0,"discounted_cash":181.0,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Custom Joint W/O Con Lt","code_information":[{"code":"12573721","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3023.0,"discounted_cash":1511.5,"setting":"both","modifiers":"LT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier LT: Left side (used to identify procedures performed on the left side of the body)"}]},{"description":"Hc Mri-Shoulder W/O Contrast Bi","code_information":[{"code":"21573222","type":"CDM"},{"code":"610","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":3738.0,"discounted_cash":1869.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Lower Extremity W/O Con Bi","code_information":[{"code":"21573720","type":"CDM"},{"code":"610","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":3792.0,"discounted_cash":1896.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Lower Ext Joint W/O Con Bi","code_information":[{"code":"21573721","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3738.0,"discounted_cash":1869.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Knee W/O Contrast Bi","code_information":[{"code":"21573722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":3738.0,"discounted_cash":1869.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Lower Ext Joint W/Con Bi","code_information":[{"code":"21574722","type":"CDM"},{"code":"610","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":12321.0,"discounted_cash":6160.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Mri-Lower Ext Joint W/Wo Con B","code_information":[{"code":"21574723","type":"CDM"},{"code":"610","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":6197.0,"discounted_cash":3098.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Clavicle Bi","code_information":[{"code":"21613000","type":"CDM"},{"code":"320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":322.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Shoulder Single View Bi","code_information":[{"code":"21613020","type":"CDM"},{"code":"320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":310.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Shoulder Min 2 Views Bi","code_information":[{"code":"21613031","type":"CDM"},{"code":"320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Humerus Min 2 Views Bi","code_information":[{"code":"21613060","type":"CDM"},{"code":"320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Elbow Min 3 Views Bi","code_information":[{"code":"21613070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Forearm 2 Views Bi","code_information":[{"code":"21613090","type":"CDM"},{"code":"320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Upper Ext Ap&Lat Inf Bi","code_information":[{"code":"21613092","type":"CDM"},{"code":"320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":385.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Wrist 2 Views Bi","code_information":[{"code":"21613100","type":"CDM"},{"code":"320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":322.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Wrist 3 Views Bi","code_information":[{"code":"21613110","type":"CDM"},{"code":"320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Hand 2 Views Bi","code_information":[{"code":"21613120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":349.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Hand Min 3 Views Bi","code_information":[{"code":"21613130","type":"CDM"},{"code":"320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Finger 2+ Views Bi","code_information":[{"code":"21613140","type":"CDM"},{"code":"320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":644.0,"discounted_cash":322.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Femur 2 Views Bi","code_information":[{"code":"21613550","type":"CDM"},{"code":"320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Knee Two Views Bi","code_information":[{"code":"21613560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Knee - 4 Vws Or More Bi","code_information":[{"code":"21613564","type":"CDM"},{"code":"320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":722.0,"discounted_cash":361.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Knee Three Views Bi","code_information":[{"code":"21613581","type":"CDM"},{"code":"320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Tibia-Fibula 2 Views Bi","code_information":[{"code":"21613590","type":"CDM"},{"code":"320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Lower Ext Ap&Lat Inf Bi","code_information":[{"code":"21613592","type":"CDM"},{"code":"320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":230.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Ankle 2 Views Bi","code_information":[{"code":"21613600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":255.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Ankle Min 3 Views Bi","code_information":[{"code":"21613610","type":"CDM"},{"code":"320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Foot 3 Or More Views Bi","code_information":[{"code":"21613630","type":"CDM"},{"code":"320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.0,"discounted_cash":266.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Foot 2 Views Bi","code_information":[{"code":"21613631","type":"CDM"},{"code":"320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":255.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Oscalcis (Heel) 2+ Views Bi","code_information":[{"code":"21613650","type":"CDM"},{"code":"320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":510.0,"discounted_cash":255.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Ankle 1 View Bi","code_information":[{"code":"21614600","type":"CDM"},{"code":"320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":460.0,"discounted_cash":230.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc X-Ray-Hand 1 View Bi","code_information":[{"code":"21615120","type":"CDM"},{"code":"320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.0,"discounted_cash":349.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc X-Ray-Knee Single View Bi","code_information":[{"code":"21618560","type":"CDM"},{"code":"320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":240.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc X-Ray-Elbow 2 Views Bi","code_information":[{"code":"21619070","type":"CDM"},{"code":"320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":621.0,"discounted_cash":310.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Ultrasound Breast Complete Rt","code_information":[{"code":"21646641","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1226.0,"discounted_cash":613.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc Ultrasound Breast Limited Rt","code_information":[{"code":"21646642","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":450.0,"setting":"both","modifiers":"RT","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier RT: Right side (used to identify procedures performed on the right side of the body)"}]},{"description":"Hc U/S Extr Non-Vasc Lmtd Bilateral","code_information":[{"code":"21646880","type":"CDM"},{"code":"402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1460.0,"discounted_cash":730.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Ultrasound Breast Complete Bilateral","code_information":[{"code":"21649641","type":"CDM"},{"code":"402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":1514.0,"discounted_cash":757.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Ultrasound Breast Limited Bilateral","code_information":[{"code":"21649642","type":"CDM"},{"code":"402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":1099.0,"discounted_cash":549.5,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Cta-Upper Extremity Bilateral","code_information":[{"code":"21663206","type":"CDM"},{"code":"352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":3186.0,"discounted_cash":1593.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Ct Lower Ext W/O Contrast Bi","code_information":[{"code":"21663700","type":"CDM"},{"code":"352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":1634.0,"discounted_cash":817.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Ct Lower Ext W/Contrast Bi","code_information":[{"code":"21663701","type":"CDM"},{"code":"352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":1542.0,"discounted_cash":771.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items. | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Cta-Lower Extremity Bilateral","code_information":[{"code":"21663706","type":"CDM"},{"code":"352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":2878.0,"discounted_cash":1439.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Multlay Comprs Lwr Leg-Bil","code_information":[{"code":"21899581","type":"CDM"},{"code":"761","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.0,"discounted_cash":228.0,"setting":"both","modifiers":"50","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier 50: Bilateral Procedure"}]},{"description":"Hc Telehealth Facility Fee","code_information":[{"code":"30200100","type":"CDM"},{"code":"780","type":"RC"},{"code":"Q3014","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Venous Blood Draw","code_information":[{"code":"32920001","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Venidraw-Kit Sent Out","code_information":[{"code":"32920002","type":"CDM"},{"code":"300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heel Stick Blood Draw","code_information":[{"code":"32920003","type":"CDM"},{"code":"300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basic Met Prof","code_information":[{"code":"32920004","type":"CDM"},{"code":"300","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electrolyte Profile","code_information":[{"code":"32920005","type":"CDM"},{"code":"300","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comprehensive Met Prof","code_information":[{"code":"32920006","type":"CDM"},{"code":"300","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipid Profile","code_information":[{"code":"32920007","type":"CDM"},{"code":"300","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Renal Function Panel","code_information":[{"code":"32920008","type":"CDM"},{"code":"300","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hepatitis Acute A/B/C","code_information":[{"code":"32920009","type":"CDM"},{"code":"300","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":257.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hepatic Function Profile","code_information":[{"code":"32920010","type":"CDM"},{"code":"300","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Acetaminophen","code_information":[{"code":"32920011","type":"CDM"},{"code":"300","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Amiodarone","code_information":[{"code":"32920013","type":"CDM"},{"code":"300","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carbamazepine","code_information":[{"code":"32920015","type":"CDM"},{"code":"300","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carbamazepine Free","code_information":[{"code":"32920016","type":"CDM"},{"code":"300","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.0,"discounted_cash":45.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cyclosporine Level","code_information":[{"code":"32920017","type":"CDM"},{"code":"300","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Clozapine","code_information":[{"code":"32920018","type":"CDM"},{"code":"300","type":"RC"},{"code":"80159","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Digoxin Total","code_information":[{"code":"32920019","type":"CDM"},{"code":"300","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valproic Acid Total","code_information":[{"code":"32920020","type":"CDM"},{"code":"300","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Valproic Acid Free","code_information":[{"code":"32920021","type":"CDM"},{"code":"300","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Everolimus Level","code_information":[{"code":"32920023","type":"CDM"},{"code":"300","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gentamicin Level","code_information":[{"code":"32920024","type":"CDM"},{"code":"300","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gabapentin, Serum","code_information":[{"code":"32920025","type":"CDM"},{"code":"300","type":"RC"},{"code":"80171","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lamotrigine, Serum","code_information":[{"code":"32920026","type":"CDM"},{"code":"300","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Levetiracetam, Serum","code_information":[{"code":"32920027","type":"CDM"},{"code":"300","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lithium Level","code_information":[{"code":"32920028","type":"CDM"},{"code":"300","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Salicylate","code_information":[{"code":"32920029","type":"CDM"},{"code":"300","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mycophenolic Acid, Serum","code_information":[{"code":"32920030","type":"CDM"},{"code":"300","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Flecainide","code_information":[{"code":"32920031","type":"CDM"},{"code":"300","type":"RC"},{"code":"80181","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oxcarbazepine","code_information":[{"code":"32920032","type":"CDM"},{"code":"300","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phenobarbital Level","code_information":[{"code":"32920033","type":"CDM"},{"code":"300","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.0,"discounted_cash":60.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phenytoin Level","code_information":[{"code":"32920034","type":"CDM"},{"code":"300","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phenytoin Free Level","code_information":[{"code":"32920035","type":"CDM"},{"code":"300","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sirolimus Quant","code_information":[{"code":"32920039","type":"CDM"},{"code":"300","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tacrolimus Level","code_information":[{"code":"32920040","type":"CDM"},{"code":"300","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Theophylline Level","code_information":[{"code":"32920041","type":"CDM"},{"code":"300","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tobramycin Level","code_information":[{"code":"32920042","type":"CDM"},{"code":"300","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.0,"discounted_cash":51.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Topiramate Level","code_information":[{"code":"32920043","type":"CDM"},{"code":"300","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vancomycin Level","code_information":[{"code":"32920044","type":"CDM"},{"code":"300","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.0,"discounted_cash":44.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Zonisamide, Serum","code_information":[{"code":"32920045","type":"CDM"},{"code":"300","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lacosamide","code_information":[{"code":"32920046","type":"CDM"},{"code":"300","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Quant, Other","code_information":[{"code":"32920047","type":"CDM"},{"code":"300","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.0,"discounted_cash":58.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Screen Pres, Inst, Stat","code_information":[{"code":"32920049","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Scn ? Ind, Dot","code_information":[{"code":"32920050","type":"CDM"},{"code":"300","type":"RC"},{"code":"80306","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Scn, Pres, Anal, Dr, Mec, Bld","code_information":[{"code":"32920051","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.0,"discounted_cash":481.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Test Pres, Per Dos","code_information":[{"code":"32920052","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":630.0,"discounted_cash":315.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Drug Scn, Pres, Anal, Per Dos","code_information":[{"code":"32920053","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.0,"discounted_cash":63.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Scn, Pres, Anal, Pc","code_information":[{"code":"32920054","type":"CDM"},{"code":"300","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol Definative Conf","code_information":[{"code":"32920056","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol Biomarkers Meconium","code_information":[{"code":"32920057","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alkaloids Nos","code_information":[{"code":"32920058","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.0,"discounted_cash":340.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amphetamine 1-2 Definative Conf","code_information":[{"code":"32920059","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amphetamine Meconium","code_information":[{"code":"32920060","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.0,"discounted_cash":268.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Amphet 5 Or More","code_information":[{"code":"32920061","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Analgesics 6 Or More","code_information":[{"code":"32920062","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antidepressant Seroton 3-5","code_information":[{"code":"32920064","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Antidepres Seroton 6 Or More","code_information":[{"code":"32920065","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antidepressant Tricyclic 1/2","code_information":[{"code":"32920066","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antidepressant Trycyclic 6 Or More","code_information":[{"code":"32920067","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Antidepres Tricylc 6 Or More","code_information":[{"code":"32920068","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Antidepres Nos","code_information":[{"code":"32920069","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antiepileptics Nos 1-3","code_information":[{"code":"32920070","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Antiepileptics Nos 7 Or More","code_information":[{"code":"32920071","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Antipsycotics Nos 7 Or More","code_information":[{"code":"32920073","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Barbiturate Defin Conf","code_information":[{"code":"32920074","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Benzodiazepine Definative Conf","code_information":[{"code":"32920076","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.0,"discounted_cash":117.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Benzodiazepines","code_information":[{"code":"32920077","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Buprenorphine","code_information":[{"code":"32920080","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cannabinoids Level","code_information":[{"code":"32920082","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carboxy-Thc Meconium","code_information":[{"code":"32920083","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cocaine Definative Conf","code_information":[{"code":"32920084","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Cocaine","code_information":[{"code":"32920085","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Fentanyls","code_information":[{"code":"32920087","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fentanyl - Serum Or Plasma","code_information":[{"code":"32920088","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Gabapentin Ua","code_information":[{"code":"32920090","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heroin Defin Conf","code_information":[{"code":"32920091","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Ketamine And Norketamine","code_information":[{"code":"32920093","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Methadone","code_information":[{"code":"32920095","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Methamphet Mda Defin Conf","code_information":[{"code":"32920097","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Mda, Mdea","code_information":[{"code":"32920098","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Methylphenidate","code_information":[{"code":"32920099","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Opiates 1 Definative Conf","code_information":[{"code":"32920100","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Opiates","code_information":[{"code":"32920101","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Opiates 5 Or More","code_information":[{"code":"32920103","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oxycodone Level","code_information":[{"code":"32920104","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Oxycodone","code_information":[{"code":"32920105","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Pregabalin","code_information":[{"code":"32920107","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Propoxyphene","code_information":[{"code":"32920109","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Propoxyphene Definative Conf","code_information":[{"code":"32920110","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Sedative Hypnotics","code_information":[{"code":"32920112","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Skeletal Muscle Relaxants 1-2","code_information":[{"code":"32920113","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.0,"discounted_cash":46.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Skeletal Muscle Rel 3 Or More","code_information":[{"code":"32920114","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Stimulants, Syn","code_information":[{"code":"32920115","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Tapentadol","code_information":[{"code":"32920116","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Tramadol","code_information":[{"code":"32920117","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Drugs Nos 7 Or More","code_information":[{"code":"32920120","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinalysis W/Microscop Auto","code_information":[{"code":"32920123","type":"CDM"},{"code":"300","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinalysis W/O  Microscop Non-Auto","code_information":[{"code":"32920124","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinalysis Poc","code_information":[{"code":"32920125","type":"CDM"},{"code":"300","type":"RC"},{"code":"81002","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urinalysis W/O Microscop Auto","code_information":[{"code":"32920126","type":"CDM"},{"code":"300","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urine Qual Poc","code_information":[{"code":"32920127","type":"CDM"},{"code":"300","type":"RC"},{"code":"81005","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Volume Meas Timed Ua","code_information":[{"code":"32920128","type":"CDM"},{"code":"300","type":"RC"},{"code":"81050","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.0,"discounted_cash":29.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bcr/Abl1 Major Cml/All Labcorp","code_information":[{"code":"32920131","type":"CDM"},{"code":"300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bcr/Abl1 Minor Cml/All Labcorp","code_information":[{"code":"32920132","type":"CDM"},{"code":"300","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.0,"discounted_cash":290.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calr Gene Com Variants Labcorp","code_information":[{"code":"32920135","type":"CDM"},{"code":"300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cystic Fibrosis Profile Labcorp","code_information":[{"code":"32920136","type":"CDM"},{"code":"300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":436.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc F2 Gene Analysis Labcorp","code_information":[{"code":"32920141","type":"CDM"},{"code":"300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor V Leiden Mutation Labcorp","code_information":[{"code":"32920142","type":"CDM"},{"code":"300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fragile X Gene Detect","code_information":[{"code":"32920143","type":"CDM"},{"code":"300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fragile X Gene Allele Character","code_information":[{"code":"32920144","type":"CDM"},{"code":"300","type":"RC"},{"code":"81244","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemochromatosis Gene Anal Labcorp","code_information":[{"code":"32920145","type":"CDM"},{"code":"300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Igh Gene","code_information":[{"code":"32920146","type":"CDM"},{"code":"300","type":"RC"},{"code":"81261","type":"HCPCS"}],"standard_charges":[{"gross_charge":860.0,"discounted_cash":430.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Igk Gene","code_information":[{"code":"32920147","type":"CDM"},{"code":"300","type":"RC"},{"code":"81264","type":"HCPCS"}],"standard_charges":[{"gross_charge":750.0,"discounted_cash":375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Jak2 Mutation Labcorp","code_information":[{"code":"32920148","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":400.0,"discounted_cash":200.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Jak2 Gene Trgt Sequence Alys Labcorp","code_information":[{"code":"32920151","type":"CDM"},{"code":"300","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mthfr Gene Labcorp","code_information":[{"code":"32920152","type":"CDM"},{"code":"300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mlh1 Gene Full Seq","code_information":[{"code":"32920153","type":"CDM"},{"code":"300","type":"RC"},{"code":"81292","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.0,"discounted_cash":1450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mlh1 Gene Dup/Delete Variant","code_information":[{"code":"32920154","type":"CDM"},{"code":"300","type":"RC"},{"code":"81294","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Msh2 Gene Full Seq","code_information":[{"code":"32920155","type":"CDM"},{"code":"300","type":"RC"},{"code":"81295","type":"HCPCS"}],"standard_charges":[{"gross_charge":1640.0,"discounted_cash":820.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Msh2 Gene Dup/Delete Variant","code_information":[{"code":"32920156","type":"CDM"},{"code":"300","type":"RC"},{"code":"81297","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Msh6 Gene Full Seq","code_information":[{"code":"32920157","type":"CDM"},{"code":"300","type":"RC"},{"code":"81298","type":"HCPCS"}],"standard_charges":[{"gross_charge":2750.0,"discounted_cash":1375.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Msh6 Gene Dup/Delete Variant","code_information":[{"code":"32920158","type":"CDM"},{"code":"300","type":"RC"},{"code":"81300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.0,"discounted_cash":515.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pms2 Gene Full Seq Analysis","code_information":[{"code":"32920162","type":"CDM"},{"code":"300","type":"RC"},{"code":"81317","type":"HCPCS"}],"standard_charges":[{"gross_charge":2900.0,"discounted_cash":1450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pms2 Gene Dup/Delet Variants","code_information":[{"code":"32920163","type":"CDM"},{"code":"300","type":"RC"},{"code":"81319","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.0,"discounted_cash":440.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mpl Gene Common Variants Labcorp","code_information":[{"code":"32920167","type":"CDM"},{"code":"300","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":660.0,"discounted_cash":330.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trb Gene","code_information":[{"code":"32920168","type":"CDM"},{"code":"300","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":900.0,"discounted_cash":450.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trg Gene","code_information":[{"code":"32920169","type":"CDM"},{"code":"300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":435.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hla Class 1 Typing Ag Labcorp","code_information":[{"code":"32920170","type":"CDM"},{"code":"300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":330.0,"discounted_cash":165.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hla Ii Type 1 Ag Equiv Lr","code_information":[{"code":"32920172","type":"CDM"},{"code":"300","type":"RC"},{"code":"81377","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mol Path Level 1","code_information":[{"code":"32920175","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mol Path Level 4","code_information":[{"code":"32920177","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mol Path Unlisted","code_information":[{"code":"32920182","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nfct Ds Chrnc Hcv 6 Assays","code_information":[{"code":"32920183","type":"CDM"},{"code":"300","type":"RC"},{"code":"81596","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.0,"discounted_cash":205.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Beta-Hydroxybutyrate Qnt","code_information":[{"code":"32920187","type":"CDM"},{"code":"300","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acth","code_information":[{"code":"32920189","type":"CDM"},{"code":"300","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Albumin Serum","code_information":[{"code":"32920190","type":"CDM"},{"code":"300","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Albumin Urine Quant","code_information":[{"code":"32920191","type":"CDM"},{"code":"300","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microalbum,24Hr Ua Quant","code_information":[{"code":"32920192","type":"CDM"},{"code":"300","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol Breath","code_information":[{"code":"32920193","type":"CDM"},{"code":"300","type":"RC"},{"code":"82075","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aldolase","code_information":[{"code":"32920194","type":"CDM"},{"code":"300","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aldosterone","code_information":[{"code":"32920195","type":"CDM"},{"code":"300","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alpha 1 Antitrypsin Total","code_information":[{"code":"32920196","type":"CDM"},{"code":"300","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alpha 1 Antitrypsin Pheno","code_information":[{"code":"32920197","type":"CDM"},{"code":"300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Afp Serum","code_information":[{"code":"32920198","type":"CDM"},{"code":"300","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aluminum","code_information":[{"code":"32920200","type":"CDM"},{"code":"300","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amino Acids Qnt 6 Or More","code_information":[{"code":"32920203","type":"CDM"},{"code":"300","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":385.0,"discounted_cash":192.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ammonia","code_information":[{"code":"32920204","type":"CDM"},{"code":"300","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amylase","code_information":[{"code":"32920205","type":"CDM"},{"code":"300","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Angiotensin 1 Conv Enzyme","code_information":[{"code":"32920207","type":"CDM"},{"code":"300","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Apolipoprotein Each","code_information":[{"code":"32920208","type":"CDM"},{"code":"300","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arsenic","code_information":[{"code":"32920209","type":"CDM"},{"code":"300","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vitamin C","code_information":[{"code":"32920210","type":"CDM"},{"code":"300","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.0,"discounted_cash":50.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Beta 2 Microglobulin","code_information":[{"code":"32920211","type":"CDM"},{"code":"300","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bile Acids","code_information":[{"code":"32920212","type":"CDM"},{"code":"300","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bilirubin Total","code_information":[{"code":"32920213","type":"CDM"},{"code":"300","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bilirubin Direct","code_information":[{"code":"32920214","type":"CDM"},{"code":"300","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Occult Bld Body Fld","code_information":[{"code":"32920216","type":"CDM"},{"code":"300","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fecal Ob Immunoassay","code_information":[{"code":"32920220","type":"CDM"},{"code":"300","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.0,"discounted_cash":81.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cadmium","code_information":[{"code":"32920221","type":"CDM"},{"code":"300","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vit D 25-Hydroxy","code_information":[{"code":"32920222","type":"CDM"},{"code":"300","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calcitonin","code_information":[{"code":"32920223","type":"CDM"},{"code":"300","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calcium Total","code_information":[{"code":"32920224","type":"CDM"},{"code":"300","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calcium Ionized","code_information":[{"code":"32920225","type":"CDM"},{"code":"300","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calcium 24 Hr Ua Qnt","code_information":[{"code":"32920226","type":"CDM"},{"code":"300","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stone Analysis Ir Spect","code_information":[{"code":"32920227","type":"CDM"},{"code":"300","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Total Co2","code_information":[{"code":"32920228","type":"CDM"},{"code":"300","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cea","code_information":[{"code":"32920229","type":"CDM"},{"code":"300","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Carnitine","code_information":[{"code":"32920230","type":"CDM"},{"code":"300","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.0,"discounted_cash":88.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Catecholamines Frac","code_information":[{"code":"32920232","type":"CDM"},{"code":"300","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ceruloplasmin","code_information":[{"code":"32920233","type":"CDM"},{"code":"300","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemiluminescent Assay","code_information":[{"code":"32920234","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chemiluminescent Assay","code_information":[{"code":"32920235","type":"CDM"},{"code":"300","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.0,"discounted_cash":386.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chloride Blood","code_information":[{"code":"32920237","type":"CDM"},{"code":"300","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chloride Urine","code_information":[{"code":"32920238","type":"CDM"},{"code":"300","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cholesterol Total","code_information":[{"code":"32920240","type":"CDM"},{"code":"300","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chromium","code_information":[{"code":"32920243","type":"CDM"},{"code":"300","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Citrate","code_information":[{"code":"32920244","type":"CDM"},{"code":"300","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Collagen Cross Links","code_information":[{"code":"32920245","type":"CDM"},{"code":"300","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Copper","code_information":[{"code":"32920246","type":"CDM"},{"code":"300","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cortisol Free","code_information":[{"code":"32920248","type":"CDM"},{"code":"300","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cortisol Total","code_information":[{"code":"32920249","type":"CDM"},{"code":"300","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gc/Ms Quant Non-Drug Related","code_information":[{"code":"32920251","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cpk Total","code_information":[{"code":"32920252","type":"CDM"},{"code":"300","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cpk Isoenzymes","code_information":[{"code":"32920253","type":"CDM"},{"code":"300","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ckmb","code_information":[{"code":"32920254","type":"CDM"},{"code":"300","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Creatinine Blood","code_information":[{"code":"32920255","type":"CDM"},{"code":"300","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Creatinine Other","code_information":[{"code":"32920256","type":"CDM"},{"code":"300","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Creat Clearance","code_information":[{"code":"32920257","type":"CDM"},{"code":"300","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryoglobulin Qual","code_information":[{"code":"32920258","type":"CDM"},{"code":"300","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vitamin B12","code_information":[{"code":"32920260","type":"CDM"},{"code":"300","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cystatin C","code_information":[{"code":"32920262","type":"CDM"},{"code":"300","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dhea","code_information":[{"code":"32920263","type":"CDM"},{"code":"300","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dhea Sulfate","code_information":[{"code":"32920264","type":"CDM"},{"code":"300","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dihydrotestosterone (Dht)","code_information":[{"code":"32920267","type":"CDM"},{"code":"300","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vit D 1 25 Dihydroxy","code_information":[{"code":"32920268","type":"CDM"},{"code":"300","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Enzyme Activity Non-Ria","code_information":[{"code":"32920270","type":"CDM"},{"code":"300","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Erythropoietin","code_information":[{"code":"32920272","type":"CDM"},{"code":"300","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Estradiol","code_information":[{"code":"32920273","type":"CDM"},{"code":"300","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Estrogens Total","code_information":[{"code":"32920275","type":"CDM"},{"code":"300","type":"RC"},{"code":"82672","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Estriol","code_information":[{"code":"32920276","type":"CDM"},{"code":"300","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Estrone","code_information":[{"code":"32920277","type":"CDM"},{"code":"300","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ethylene Glycol","code_information":[{"code":"32920278","type":"CDM"},{"code":"300","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fecal Fat Qual","code_information":[{"code":"32920279","type":"CDM"},{"code":"300","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ferritin","code_information":[{"code":"32920282","type":"CDM"},{"code":"300","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fetal Fibronectin","code_information":[{"code":"32920283","type":"CDM"},{"code":"300","type":"RC"},{"code":"82731","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Folic Acid","code_information":[{"code":"32920284","type":"CDM"},{"code":"300","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Folic Acid Rbc","code_information":[{"code":"32920285","type":"CDM"},{"code":"300","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gammaglob Adgm Each","code_information":[{"code":"32920287","type":"CDM"},{"code":"300","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ige","code_information":[{"code":"32920288","type":"CDM"},{"code":"300","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoglob Subclass Each","code_information":[{"code":"32920289","type":"CDM"},{"code":"300","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gastrin","code_information":[{"code":"32920290","type":"CDM"},{"code":"300","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucagon","code_information":[{"code":"32920291","type":"CDM"},{"code":"300","type":"RC"},{"code":"82943","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucose Body Fluid","code_information":[{"code":"32920292","type":"CDM"},{"code":"300","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucose Quant Blood","code_information":[{"code":"32920293","type":"CDM"},{"code":"300","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucose Post Glu Dose","code_information":[{"code":"32920294","type":"CDM"},{"code":"300","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gluc Tolerance 3 Spec & Gluc","code_information":[{"code":"32920295","type":"CDM"},{"code":"300","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gluc Tol Added Hrs","code_information":[{"code":"32920296","type":"CDM"},{"code":"300","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glu-6-Phos-Dehydrog Qnt","code_information":[{"code":"32920297","type":"CDM"},{"code":"300","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucose By Poc Device","code_information":[{"code":"32920298","type":"CDM"},{"code":"300","type":"RC"},{"code":"82962","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ggt","code_information":[{"code":"32920299","type":"CDM"},{"code":"300","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fsh","code_information":[{"code":"32920301","type":"CDM"},{"code":"300","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Luteinizing Hormone","code_information":[{"code":"32920302","type":"CDM"},{"code":"300","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Human Growth Hormone","code_information":[{"code":"32920303","type":"CDM"},{"code":"300","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Haptoglobin Quant","code_information":[{"code":"32920304","type":"CDM"},{"code":"300","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc H. Pylori Breath Test","code_information":[{"code":"32920305","type":"CDM"},{"code":"300","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hgb Fract & Quant Electrophor","code_information":[{"code":"32920309","type":"CDM"},{"code":"300","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemoglobin A1C","code_information":[{"code":"32920311","type":"CDM"},{"code":"300","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Methemoglobin Quant","code_information":[{"code":"32920312","type":"CDM"},{"code":"300","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Histamine","code_information":[{"code":"32920316","type":"CDM"},{"code":"300","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.0,"discounted_cash":297.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Homocysteine","code_information":[{"code":"32920317","type":"CDM"},{"code":"300","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 5-Hiaa","code_information":[{"code":"32920320","type":"CDM"},{"code":"300","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 17-D-Hydroxyprogesterone","code_information":[{"code":"32920321","type":"CDM"},{"code":"300","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoassay Non-Inf Qual Multi Step","code_information":[{"code":"32920322","type":"CDM"},{"code":"300","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoassay Non-Inf Qnt Ria","code_information":[{"code":"32920323","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoassay Quant Nos","code_information":[{"code":"32920324","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoassay Quant Nos Nonab","code_information":[{"code":"32920325","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insulin Total","code_information":[{"code":"32920326","type":"CDM"},{"code":"300","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insulin Free","code_information":[{"code":"32920327","type":"CDM"},{"code":"300","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iron","code_information":[{"code":"32920328","type":"CDM"},{"code":"300","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iron Binding Capacity","code_information":[{"code":"32920329","type":"CDM"},{"code":"300","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lactic Acid","code_information":[{"code":"32920331","type":"CDM"},{"code":"300","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ldh","code_information":[{"code":"32920332","type":"CDM"},{"code":"300","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ld Isoenzymes","code_information":[{"code":"32920333","type":"CDM"},{"code":"300","type":"RC"},{"code":"83625","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lactoferrin Quant","code_information":[{"code":"32920335","type":"CDM"},{"code":"300","type":"RC"},{"code":"83631","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lead","code_information":[{"code":"32920336","type":"CDM"},{"code":"300","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipase","code_information":[{"code":"32920339","type":"CDM"},{"code":"300","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipoprotein (A)","code_information":[{"code":"32920340","type":"CDM"},{"code":"300","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipoprot Part Subclasses Qnt","code_information":[{"code":"32920342","type":"CDM"},{"code":"300","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hdl Cholesterol","code_information":[{"code":"32920343","type":"CDM"},{"code":"300","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ldl Chol Direct","code_information":[{"code":"32920344","type":"CDM"},{"code":"300","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Magnesium","code_information":[{"code":"32920345","type":"CDM"},{"code":"300","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manganese","code_information":[{"code":"32920346","type":"CDM"},{"code":"300","type":"RC"},{"code":"83785","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.0,"discounted_cash":108.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mass Spect Qual/Qnt Nos","code_information":[{"code":"32920347","type":"CDM"},{"code":"300","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.0,"discounted_cash":93.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mercury Quant","code_information":[{"code":"32920348","type":"CDM"},{"code":"300","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Metanephrines","code_information":[{"code":"32920349","type":"CDM"},{"code":"300","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myelin Basic Protein Csf","code_information":[{"code":"32920350","type":"CDM"},{"code":"300","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myoglobin","code_information":[{"code":"32920351","type":"CDM"},{"code":"300","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bnp Natriuretic Peptide","code_information":[{"code":"32920352","type":"CDM"},{"code":"300","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":308.0,"discounted_cash":154.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nephelometry Ea Analyte Nos","code_information":[{"code":"32920353","type":"CDM"},{"code":"300","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oligoclonal Bands","code_information":[{"code":"32920355","type":"CDM"},{"code":"300","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Organic Acid Tot Ea Spec Qual","code_information":[{"code":"32920357","type":"CDM"},{"code":"300","type":"RC"},{"code":"83919","type":"HCPCS"}],"standard_charges":[{"gross_charge":259.0,"discounted_cash":129.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Organic Acid Single Quant","code_information":[{"code":"32920358","type":"CDM"},{"code":"300","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osmolality Blood","code_information":[{"code":"32920359","type":"CDM"},{"code":"300","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osmolality Urine","code_information":[{"code":"32920360","type":"CDM"},{"code":"300","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Osteocalcin","code_information":[{"code":"32920361","type":"CDM"},{"code":"300","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Oxalate","code_information":[{"code":"32920362","type":"CDM"},{"code":"300","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Parathormone","code_information":[{"code":"32920363","type":"CDM"},{"code":"300","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ph Body Fluid","code_information":[{"code":"32920364","type":"CDM"},{"code":"300","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pc Phencyclidine","code_information":[{"code":"32920365","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.0,"discounted_cash":11.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Calprotectin Fecal","code_information":[{"code":"32920368","type":"CDM"},{"code":"300","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pku","code_information":[{"code":"32920369","type":"CDM"},{"code":"300","type":"RC"},{"code":"84030","type":"HCPCS"}],"standard_charges":[{"gross_charge":412.0,"discounted_cash":206.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acid Phos Prostatic","code_information":[{"code":"32920370","type":"CDM"},{"code":"300","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alk Phos Total","code_information":[{"code":"32920371","type":"CDM"},{"code":"300","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alk Phos Isoenzymes","code_information":[{"code":"32920372","type":"CDM"},{"code":"300","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phosphorus Blood","code_information":[{"code":"32920374","type":"CDM"},{"code":"300","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phosphorus Urine","code_information":[{"code":"32920375","type":"CDM"},{"code":"300","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":72.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Amnisure - Pamg-1 Vag Secretion Qual","code_information":[{"code":"32920377","type":"CDM"},{"code":"300","type":"RC"},{"code":"84112","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.0,"discounted_cash":90.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Potassium Blood","code_information":[{"code":"32920379","type":"CDM"},{"code":"300","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Potassium Urine","code_information":[{"code":"32920380","type":"CDM"},{"code":"300","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prealbumin","code_information":[{"code":"32920381","type":"CDM"},{"code":"300","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pregnenolone","code_information":[{"code":"32920382","type":"CDM"},{"code":"300","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Progesterone","code_information":[{"code":"32920384","type":"CDM"},{"code":"300","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Procalcitonin","code_information":[{"code":"32920385","type":"CDM"},{"code":"300","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Prolactin","code_information":[{"code":"32920386","type":"CDM"},{"code":"300","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Psa Total","code_information":[{"code":"32920388","type":"CDM"},{"code":"300","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Psa Free","code_information":[{"code":"32920389","type":"CDM"},{"code":"300","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Total Blood","code_information":[{"code":"32920390","type":"CDM"},{"code":"300","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Total Urine","code_information":[{"code":"32920391","type":"CDM"},{"code":"300","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Total Other","code_information":[{"code":"32920392","type":"CDM"},{"code":"300","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Elec Frac Serum","code_information":[{"code":"32920394","type":"CDM"},{"code":"300","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Elec Frac Other","code_information":[{"code":"32920395","type":"CDM"},{"code":"300","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein West Blot","code_information":[{"code":"32920396","type":"CDM"},{"code":"300","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Proinsulin","code_information":[{"code":"32920400","type":"CDM"},{"code":"300","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pyridoxal Phos (Vit B6)","code_information":[{"code":"32920401","type":"CDM"},{"code":"300","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.0,"discounted_cash":112.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pyruvate","code_information":[{"code":"32920402","type":"CDM"},{"code":"300","type":"RC"},{"code":"84210","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Renin","code_information":[{"code":"32920404","type":"CDM"},{"code":"300","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Riboflavin (Vitamin B-2)","code_information":[{"code":"32920405","type":"CDM"},{"code":"300","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Selenium","code_information":[{"code":"32920406","type":"CDM"},{"code":"300","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Serotonin","code_information":[{"code":"32920407","type":"CDM"},{"code":"300","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":120.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sex Hormone Bind Glob","code_information":[{"code":"32920408","type":"CDM"},{"code":"300","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sodium Blood","code_information":[{"code":"32920409","type":"CDM"},{"code":"300","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sodium  Ua","code_information":[{"code":"32920410","type":"CDM"},{"code":"300","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Somatomedin","code_information":[{"code":"32920412","type":"CDM"},{"code":"300","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sugar Qual Single","code_information":[{"code":"32920416","type":"CDM"},{"code":"300","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Testosterone Free","code_information":[{"code":"32920419","type":"CDM"},{"code":"300","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Testosterone Total","code_information":[{"code":"32920420","type":"CDM"},{"code":"300","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.0,"discounted_cash":102.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thiamine (Vit B1)","code_information":[{"code":"32920422","type":"CDM"},{"code":"300","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroglobulin","code_information":[{"code":"32920423","type":"CDM"},{"code":"300","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroxin T4 Total","code_information":[{"code":"32920424","type":"CDM"},{"code":"300","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.0,"discounted_cash":36.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroxin T4 Free","code_information":[{"code":"32920425","type":"CDM"},{"code":"300","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroxine Binding Globulin","code_information":[{"code":"32920427","type":"CDM"},{"code":"300","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tsh","code_information":[{"code":"32920428","type":"CDM"},{"code":"300","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroid Stim Immun Glob","code_information":[{"code":"32920429","type":"CDM"},{"code":"300","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tocopherol (Vit E)","code_information":[{"code":"32920430","type":"CDM"},{"code":"300","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transferase Asp (Ast)","code_information":[{"code":"32920431","type":"CDM"},{"code":"300","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transferase Ala (Alt)","code_information":[{"code":"32920432","type":"CDM"},{"code":"300","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Transferrin","code_information":[{"code":"32920433","type":"CDM"},{"code":"300","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Triglycerides","code_information":[{"code":"32920434","type":"CDM"},{"code":"300","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T3 Uptake","code_information":[{"code":"32920435","type":"CDM"},{"code":"300","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.0,"discounted_cash":48.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T3 Total","code_information":[{"code":"32920436","type":"CDM"},{"code":"300","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T3 Free","code_information":[{"code":"32920437","type":"CDM"},{"code":"300","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T3 Reverse","code_information":[{"code":"32920438","type":"CDM"},{"code":"300","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Troponin  Quant","code_information":[{"code":"32920439","type":"CDM"},{"code":"300","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urea Nitrogen (Bun)","code_information":[{"code":"32920442","type":"CDM"},{"code":"300","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Urea Nitrogen Ua","code_information":[{"code":"32920443","type":"CDM"},{"code":"300","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Uric Acid Blood","code_information":[{"code":"32920445","type":"CDM"},{"code":"300","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Uric Acid Other","code_information":[{"code":"32920446","type":"CDM"},{"code":"300","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vma Ua","code_information":[{"code":"32920447","type":"CDM"},{"code":"300","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vip (Vaso Int Poly)","code_information":[{"code":"32920448","type":"CDM"},{"code":"300","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vitamin A","code_information":[{"code":"32920450","type":"CDM"},{"code":"300","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vitamin K1","code_information":[{"code":"32920452","type":"CDM"},{"code":"300","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Zinc","code_information":[{"code":"32920453","type":"CDM"},{"code":"300","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C-Peptide","code_information":[{"code":"32920454","type":"CDM"},{"code":"300","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hcg Quant","code_information":[{"code":"32920455","type":"CDM"},{"code":"300","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hcg Qual","code_information":[{"code":"32920456","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hcg Poc","code_information":[{"code":"32920457","type":"CDM"},{"code":"300","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.0,"discounted_cash":43.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Manual Diff Automated","code_information":[{"code":"32920459","type":"CDM"},{"code":"300","type":"RC"},{"code":"85004","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hct Spun","code_information":[{"code":"32920460","type":"CDM"},{"code":"300","type":"RC"},{"code":"85013","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hct","code_information":[{"code":"32920461","type":"CDM"},{"code":"300","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":20.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hgb","code_information":[{"code":"32920462","type":"CDM"},{"code":"300","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":20.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cbc W/Auto Diff","code_information":[{"code":"32920463","type":"CDM"},{"code":"300","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cbc No Diff","code_information":[{"code":"32920464","type":"CDM"},{"code":"300","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rbc","code_information":[{"code":"32920465","type":"CDM"},{"code":"300","type":"RC"},{"code":"85041","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Retic Auto W/Cell Paramtrs, Direct Meas","code_information":[{"code":"32920467","type":"CDM"},{"code":"300","type":"RC"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Wbc","code_information":[{"code":"32920468","type":"CDM"},{"code":"300","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Platelet Count Auto","code_information":[{"code":"32920469","type":"CDM"},{"code":"300","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Reticulated Platelet Assay","code_information":[{"code":"32920470","type":"CDM"},{"code":"300","type":"RC"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":345.0,"discounted_cash":172.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor Ii Activity","code_information":[{"code":"32920472","type":"CDM"},{"code":"300","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor V Activity","code_information":[{"code":"32920473","type":"CDM"},{"code":"300","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor Vii Activity","code_information":[{"code":"32920474","type":"CDM"},{"code":"300","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor Viii Activity","code_information":[{"code":"32920475","type":"CDM"},{"code":"300","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vw Fact Ristocetin Cofactor","code_information":[{"code":"32920476","type":"CDM"},{"code":"300","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Von Will Factor Ag","code_information":[{"code":"32920477","type":"CDM"},{"code":"300","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Factor Ix","code_information":[{"code":"32920479","type":"CDM"},{"code":"300","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.0,"discounted_cash":98.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anti-Thromb Iii Activity","code_information":[{"code":"32920482","type":"CDM"},{"code":"300","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anti-Thromb Iii Ag","code_information":[{"code":"32920483","type":"CDM"},{"code":"300","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein C Antigen","code_information":[{"code":"32920484","type":"CDM"},{"code":"300","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein C Activity","code_information":[{"code":"32920485","type":"CDM"},{"code":"300","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein S Total","code_information":[{"code":"32920486","type":"CDM"},{"code":"300","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein S Free","code_information":[{"code":"32920487","type":"CDM"},{"code":"300","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Act Protei C Resist","code_information":[{"code":"32920488","type":"CDM"},{"code":"300","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.0,"discounted_cash":80.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Act Clotting Time","code_information":[{"code":"32920490","type":"CDM"},{"code":"300","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibrinogen Deg Prod Semi Quant","code_information":[{"code":"32920491","type":"CDM"},{"code":"300","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc D-Dimer Quant","code_information":[{"code":"32920493","type":"CDM"},{"code":"300","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fibrinogen Activity","code_information":[{"code":"32920494","type":"CDM"},{"code":"300","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coag Func Act Nos","code_information":[{"code":"32920496","type":"CDM"},{"code":"300","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":299.0,"discounted_cash":149.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heparin Assay","code_information":[{"code":"32920500","type":"CDM"},{"code":"300","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Muramidase","code_information":[{"code":"32920502","type":"CDM"},{"code":"300","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hexagonal Phoso Lipid","code_information":[{"code":"32920505","type":"CDM"},{"code":"300","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protime","code_information":[{"code":"32920506","type":"CDM"},{"code":"300","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protime Plasma Fractions","code_information":[{"code":"32920507","type":"CDM"},{"code":"300","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drvvt Diluted Russ Viper Ven Tm","code_information":[{"code":"32920508","type":"CDM"},{"code":"300","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sed Rate Non-Auto","code_information":[{"code":"32920510","type":"CDM"},{"code":"300","type":"RC"},{"code":"85651","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rbc Sed Rate Automated","code_information":[{"code":"32920511","type":"CDM"},{"code":"300","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thrombin Time","code_information":[{"code":"32920513","type":"CDM"},{"code":"300","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thromboplastin Inhib Tiss","code_information":[{"code":"32920514","type":"CDM"},{"code":"300","type":"RC"},{"code":"85705","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ptt","code_information":[{"code":"32920515","type":"CDM"},{"code":"300","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ptt Plasma Fractions","code_information":[{"code":"32920516","type":"CDM"},{"code":"300","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":40.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Viscosity","code_information":[{"code":"32920517","type":"CDM"},{"code":"300","type":"RC"},{"code":"85810","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allergen Specific Ige Quant Ea","code_information":[{"code":"32920519","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allergen Ige Quant Ea Comp","code_information":[{"code":"32920520","type":"CDM"},{"code":"300","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ab Id Plt Abs","code_information":[{"code":"32920522","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.0,"discounted_cash":504.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ana","code_information":[{"code":"32920524","type":"CDM"},{"code":"300","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aso Titer","code_information":[{"code":"32920526","type":"CDM"},{"code":"300","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C-Reactive Protein","code_information":[{"code":"32920527","type":"CDM"},{"code":"300","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Crp High Sens","code_information":[{"code":"32920528","type":"CDM"},{"code":"300","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Beta-2 Glycoprot Ab","code_information":[{"code":"32920529","type":"CDM"},{"code":"300","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cardiolipin Ab Each Class","code_information":[{"code":"32920530","type":"CDM"},{"code":"300","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Phospholipid Ab","code_information":[{"code":"32920531","type":"CDM"},{"code":"300","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cold Agglutinin Screen Arc","code_information":[{"code":"32920532","type":"CDM"},{"code":"300","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Complement Ag Ea","code_information":[{"code":"32920534","type":"CDM"},{"code":"300","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Complement Function","code_information":[{"code":"32920535","type":"CDM"},{"code":"300","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Complement Tot Ch50","code_information":[{"code":"32920536","type":"CDM"},{"code":"300","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cyclic Cit Peptide Ab","code_information":[{"code":"32920538","type":"CDM"},{"code":"300","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dna Ab Native / Ds","code_information":[{"code":"32920540","type":"CDM"},{"code":"300","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ena Ab","code_information":[{"code":"32920541","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nuclear Antigen Antibody","code_information":[{"code":"32920542","type":"CDM"},{"code":"300","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.0,"discounted_cash":219.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluorescent Ab Scn Non-Inf","code_information":[{"code":"32920543","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluorescent Non-Inf Ab Titer","code_information":[{"code":"32920545","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Adrenal Fluorescent Ab Titer","code_information":[{"code":"32920546","type":"CDM"},{"code":"300","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.0,"discounted_cash":180.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ca 15-3  / 27.29","code_information":[{"code":"32920547","type":"CDM"},{"code":"300","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ca 19-9","code_information":[{"code":"32920548","type":"CDM"},{"code":"300","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ca 125","code_information":[{"code":"32920549","type":"CDM"},{"code":"300","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heterophile Screen","code_information":[{"code":"32920551","type":"CDM"},{"code":"300","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tumor Ag Quant Other","code_information":[{"code":"32920552","type":"CDM"},{"code":"300","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Ab Nos Quant","code_information":[{"code":"32920553","type":"CDM"},{"code":"300","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunodiff Nos Qual","code_information":[{"code":"32920554","type":"CDM"},{"code":"300","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunofixation Electro Serum","code_information":[{"code":"32920556","type":"CDM"},{"code":"300","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunofixation Electro Other","code_information":[{"code":"32920557","type":"CDM"},{"code":"300","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inhibin A","code_information":[{"code":"32920558","type":"CDM"},{"code":"300","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insulin Ab","code_information":[{"code":"32920559","type":"CDM"},{"code":"300","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Intrinsic Factor Ab","code_information":[{"code":"32920560","type":"CDM"},{"code":"300","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Islet Cell Ab","code_information":[{"code":"32920561","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":104.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cellular Function Assay","code_information":[{"code":"32920563","type":"CDM"},{"code":"300","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1002.0,"discounted_cash":501.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc B-Cells Total Count","code_information":[{"code":"32920565","type":"CDM"},{"code":"300","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mononuclear Cell Antigen","code_information":[{"code":"32920566","type":"CDM"},{"code":"300","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nk Cells Total","code_information":[{"code":"32920567","type":"CDM"},{"code":"300","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T Cells Total","code_information":[{"code":"32920568","type":"CDM"},{"code":"300","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":342.0,"discounted_cash":171.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cd4 Cd8 Count","code_information":[{"code":"32920569","type":"CDM"},{"code":"300","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.0,"discounted_cash":199.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc T Cells Cd4 Count","code_information":[{"code":"32920570","type":"CDM"},{"code":"300","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microsomal Ab","code_information":[{"code":"32920571","type":"CDM"},{"code":"300","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ra Quant","code_information":[{"code":"32920576","type":"CDM"},{"code":"300","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tb Test Interferon","code_information":[{"code":"32920577","type":"CDM"},{"code":"300","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.0,"discounted_cash":255.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Syphilis Test Qual","code_information":[{"code":"32920579","type":"CDM"},{"code":"300","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Syphillis Test Quant","code_information":[{"code":"32920580","type":"CDM"},{"code":"300","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.0,"discounted_cash":28.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aspergillus Ab","code_information":[{"code":"32920582","type":"CDM"},{"code":"300","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bacterium Ab Nos","code_information":[{"code":"32920583","type":"CDM"},{"code":"300","type":"RC"},{"code":"86609","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bartonella Ab","code_information":[{"code":"32920584","type":"CDM"},{"code":"300","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blastomyces Ab","code_information":[{"code":"32920585","type":"CDM"},{"code":"300","type":"RC"},{"code":"86612","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bordetella Ab","code_information":[{"code":"32920586","type":"CDM"},{"code":"300","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Borrelia Burgdorf Ab Confirm","code_information":[{"code":"32920587","type":"CDM"},{"code":"300","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Borrelia Burgdorf Ab (Lyme Dis)","code_information":[{"code":"32920588","type":"CDM"},{"code":"300","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Candida Ab","code_information":[{"code":"32920590","type":"CDM"},{"code":"300","type":"RC"},{"code":"86628","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chlamydia Ab","code_information":[{"code":"32920591","type":"CDM"},{"code":"300","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chlamydia Ab Igm","code_information":[{"code":"32920592","type":"CDM"},{"code":"300","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Coccidioides Ab","code_information":[{"code":"32920593","type":"CDM"},{"code":"300","type":"RC"},{"code":"86635","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cmv Ab","code_information":[{"code":"32920596","type":"CDM"},{"code":"300","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cmv Ab Igm","code_information":[{"code":"32920597","type":"CDM"},{"code":"300","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Enterovirus Ab","code_information":[{"code":"32920603","type":"CDM"},{"code":"300","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ebv Early Ag","code_information":[{"code":"32920604","type":"CDM"},{"code":"300","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.0,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ebv Nuclear Ag","code_information":[{"code":"32920605","type":"CDM"},{"code":"300","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ebv Capsid Ab","code_information":[{"code":"32920606","type":"CDM"},{"code":"300","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Francisella Tular Ab","code_information":[{"code":"32920607","type":"CDM"},{"code":"300","type":"RC"},{"code":"86668","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fungal Ab Nos","code_information":[{"code":"32920608","type":"CDM"},{"code":"300","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc H Pylori Ab","code_information":[{"code":"32920609","type":"CDM"},{"code":"300","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hsv Non Spec Ab","code_information":[{"code":"32920613","type":"CDM"},{"code":"300","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hsv Type 1 Ab","code_information":[{"code":"32920614","type":"CDM"},{"code":"300","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hsv Type 2 Ab","code_information":[{"code":"32920615","type":"CDM"},{"code":"300","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Histoplasma Ab","code_information":[{"code":"32920616","type":"CDM"},{"code":"300","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep B Core Ab Total","code_information":[{"code":"32920620","type":"CDM"},{"code":"300","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep B Core Ab Igm","code_information":[{"code":"32920621","type":"CDM"},{"code":"300","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep B Surf Ab","code_information":[{"code":"32920622","type":"CDM"},{"code":"300","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep Be Ab","code_information":[{"code":"32920623","type":"CDM"},{"code":"300","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep A Ab","code_information":[{"code":"32920624","type":"CDM"},{"code":"300","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep A Ab Igm","code_information":[{"code":"32920625","type":"CDM"},{"code":"300","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":113.0,"discounted_cash":56.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Jc Virus Ab","code_information":[{"code":"32920627","type":"CDM"},{"code":"300","type":"RC"},{"code":"86711","type":"HCPCS"}],"standard_charges":[{"gross_charge":9715.0,"discounted_cash":4857.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mumps Ab","code_information":[{"code":"32920630","type":"CDM"},{"code":"300","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mycoplasma Ab","code_information":[{"code":"32920631","type":"CDM"},{"code":"300","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Parvovirus Ab","code_information":[{"code":"32920633","type":"CDM"},{"code":"300","type":"RC"},{"code":"86747","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.0,"discounted_cash":67.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rubella Ab","code_information":[{"code":"32920638","type":"CDM"},{"code":"300","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rubeola Ab","code_information":[{"code":"32920639","type":"CDM"},{"code":"300","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sars-Cov-2 Antibody","code_information":[{"code":"32920641","type":"CDM"},{"code":"300","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":104.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Toxoplasm Ab Igm","code_information":[{"code":"32920644","type":"CDM"},{"code":"300","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Treponema Ab","code_information":[{"code":"32920645","type":"CDM"},{"code":"300","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Varicella Zoster Ab","code_information":[{"code":"32920646","type":"CDM"},{"code":"300","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Thyroglobulin Ab","code_information":[{"code":"32920650","type":"CDM"},{"code":"300","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep C Ab","code_information":[{"code":"32920651","type":"CDM"},{"code":"300","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.0,"discounted_cash":66.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ab Screen (Arc)","code_information":[{"code":"32920655","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ab Elution Rbc Each (Arc)","code_information":[{"code":"32920656","type":"CDM"},{"code":"300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antibody Id Ea Panel (Arc)","code_information":[{"code":"32920657","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.0,"discounted_cash":100.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ahg Direct Each (Arc)","code_information":[{"code":"32920658","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ahg Indirect Qual Ea Reag Cell (Arc)","code_information":[{"code":"32920659","type":"CDM"},{"code":"300","type":"RC"},{"code":"86885","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ahg Indirect Ea Ab Titer (Arc)","code_information":[{"code":"32920660","type":"CDM"},{"code":"300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Abo (Arc)","code_information":[{"code":"32920661","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":82.0,"discounted_cash":41.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Rh (Arc)","code_information":[{"code":"32920662","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ag Scn Donor Bld Each Ag","code_information":[{"code":"32920663","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ag Scn Rbc Ag Each  (Arc)","code_information":[{"code":"32920664","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.0,"discounted_cash":59.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rh Phenotype Complete (Arc)","code_information":[{"code":"32920665","type":"CDM"},{"code":"300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.0,"discounted_cash":88.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pretreat Rbc / Ab Detect  W/Chem (Arc)","code_information":[{"code":"32920668","type":"CDM"},{"code":"300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pretreat Rbc / Ab Detect W/Enz (Arc)","code_information":[{"code":"32920669","type":"CDM"},{"code":"300","type":"RC"},{"code":"86971","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pretreat Rbc / Ab Detect W/Dens Sep (Arc","code_information":[{"code":"32920670","type":"CDM"},{"code":"300","type":"RC"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":341.0,"discounted_cash":170.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pretreat Serum / Ab Det Inc Inhib (Arc)","code_information":[{"code":"32920672","type":"CDM"},{"code":"300","type":"RC"},{"code":"86977","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.0,"discounted_cash":214.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pretreat Ser / Ab Det Rbc Absorp (Arc)","code_information":[{"code":"32920673","type":"CDM"},{"code":"300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Concentration Inf Agnt","code_information":[{"code":"32920674","type":"CDM"},{"code":"300","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Bld Aer W/Iso & Pres  Id","code_information":[{"code":"32920675","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Bld Aer W/Iso & Pres Id (Add)","code_information":[{"code":"32920676","type":"CDM"},{"code":"300","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Stool Sal/Shig","code_information":[{"code":"32920677","type":"CDM"},{"code":"300","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Stool Add Path","code_information":[{"code":"32920678","type":"CDM"},{"code":"300","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Aerobic W/Iso & Pres Id","code_information":[{"code":"32920679","type":"CDM"},{"code":"300","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Anaer W/Iso & Pres Id","code_information":[{"code":"32920680","type":"CDM"},{"code":"300","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Organism Id Definit Anaer","code_information":[{"code":"32920681","type":"CDM"},{"code":"300","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Organism Id Definit Aer","code_information":[{"code":"32920682","type":"CDM"},{"code":"300","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Path Org Presump Scn","code_information":[{"code":"32920683","type":"CDM"},{"code":"300","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Urine W/ Qnt Col Cnt","code_information":[{"code":"32920684","type":"CDM"},{"code":"300","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Urine W/Iso & Pres Id Isol Ea","code_information":[{"code":"32920685","type":"CDM"},{"code":"300","type":"RC"},{"code":"87088","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fungal Cult Skin Hair Nail","code_information":[{"code":"32920686","type":"CDM"},{"code":"300","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Fung Other","code_information":[{"code":"32920687","type":"CDM"},{"code":"300","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Fung Blood","code_information":[{"code":"32920688","type":"CDM"},{"code":"300","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.0,"discounted_cash":138.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fungal Definit Id Yeast","code_information":[{"code":"32920689","type":"CDM"},{"code":"300","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Acid Fast W/Iso & Pres Id","code_information":[{"code":"32920693","type":"CDM"},{"code":"300","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cult Typing Dna Seq","code_information":[{"code":"32920698","type":"CDM"},{"code":"300","type":"RC"},{"code":"87153","type":"HCPCS"}],"standard_charges":[{"gross_charge":1408.0,"discounted_cash":704.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arthropod Macro Exam","code_information":[{"code":"32920699","type":"CDM"},{"code":"300","type":"RC"},{"code":"87168","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.0,"discounted_cash":36.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tiss Homogenization For Cult","code_information":[{"code":"32920702","type":"CDM"},{"code":"300","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc O&P Dir Sm Conc & Id","code_information":[{"code":"32920703","type":"CDM"},{"code":"300","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suscept Disk Meth Per Plate","code_information":[{"code":"32920705","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Suscept Mic Per Plate","code_information":[{"code":"32920707","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stain Primary W/ Interp Gram / Giemsa","code_information":[{"code":"32920710","type":"CDM"},{"code":"300","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.0,"discounted_cash":41.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stain Primary W/ Interp Fluor / Afb","code_information":[{"code":"32920711","type":"CDM"},{"code":"300","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stain Complex For O&P","code_information":[{"code":"32920713","type":"CDM"},{"code":"300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":248.0,"discounted_cash":124.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Stain Primary Wet Mount For Inf Ag","code_information":[{"code":"32920714","type":"CDM"},{"code":"300","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.0,"discounted_cash":55.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Virus Cult Tiss Isol & Presump Id","code_information":[{"code":"32920715","type":"CDM"},{"code":"300","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.0,"discounted_cash":146.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C Diff Toxin Ag Eia Qual","code_information":[{"code":"32920725","type":"CDM"},{"code":"300","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cryptosporidium Ag","code_information":[{"code":"32920727","type":"CDM"},{"code":"300","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Giardia Ag Eia Qual","code_information":[{"code":"32920728","type":"CDM"},{"code":"300","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc H Pylori Ag Eia Qual Stool","code_information":[{"code":"32920730","type":"CDM"},{"code":"300","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.0,"discounted_cash":96.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep B Surf Ag Eia Qual","code_information":[{"code":"32920731","type":"CDM"},{"code":"300","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep Be Ag Eia Qual","code_information":[{"code":"32920733","type":"CDM"},{"code":"300","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hiv 1 Ag W/Hiv 1-2 Abs Eia","code_information":[{"code":"32920736","type":"CDM"},{"code":"300","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rotavirus Ag Eia Qual","code_information":[{"code":"32920737","type":"CDM"},{"code":"300","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Shigatoxin Ag","code_information":[{"code":"32920738","type":"CDM"},{"code":"300","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Infect Agent Ag Eia Qual Nos","code_information":[{"code":"32920739","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.0,"discounted_cash":82.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Borr Burg Amp Probe","code_information":[{"code":"32920741","type":"CDM"},{"code":"300","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":209.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Meningitis Qual Pcr Csf","code_information":[{"code":"32920743","type":"CDM"},{"code":"300","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2290.0,"discounted_cash":1145.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chlam Trach Dna/Rna Amp Probe","code_information":[{"code":"32920745","type":"CDM"},{"code":"300","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C Diff Amp Probe","code_information":[{"code":"32920746","type":"CDM"},{"code":"300","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cmv Dna Amp Pb","code_information":[{"code":"32920747","type":"CDM"},{"code":"300","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cmv Dna / Rna Quant","code_information":[{"code":"32920748","type":"CDM"},{"code":"300","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Influenza Dna Amp Probe","code_information":[{"code":"32920750","type":"CDM"},{"code":"300","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1160.0,"discounted_cash":580.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Gastrointest Path Pcr 12-25","code_information":[{"code":"32920752","type":"CDM"},{"code":"300","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":4947.0,"discounted_cash":2473.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep B Viral Dna Quant","code_information":[{"code":"32920755","type":"CDM"},{"code":"300","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":913.0,"discounted_cash":456.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep C Dna/Rna Quant","code_information":[{"code":"32920757","type":"CDM"},{"code":"300","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hsv Dna/Rna Amp Probe","code_information":[{"code":"32920758","type":"CDM"},{"code":"300","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hiv-1 Dna/Rna Quant","code_information":[{"code":"32920760","type":"CDM"},{"code":"300","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mycobact Tub Dna Amp Pb","code_information":[{"code":"32920761","type":"CDM"},{"code":"300","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neis Gon Dna/Rna Amp Probe","code_information":[{"code":"32920763","type":"CDM"},{"code":"300","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hpv High Risk Types","code_information":[{"code":"32920764","type":"CDM"},{"code":"300","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hpv Types 16 & 18 Only","code_information":[{"code":"32920765","type":"CDM"},{"code":"300","type":"RC"},{"code":"87625","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":262.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Respiratory Virus 3-5 Targets","code_information":[{"code":"32920766","type":"CDM"},{"code":"300","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":1741.0,"discounted_cash":870.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sars-Cov-2 Amp Prb","code_information":[{"code":"32920768","type":"CDM"},{"code":"300","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":257.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Staph Aur Dna Amp Pb","code_information":[{"code":"32920769","type":"CDM"},{"code":"300","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mrsa Dna/Rna Amp Probe","code_information":[{"code":"32920770","type":"CDM"},{"code":"300","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Trich Vag Dna/Rna Amp Probe","code_information":[{"code":"32920773","type":"CDM"},{"code":"300","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Nos Dna/Rna Amp Probe","code_information":[{"code":"32920774","type":"CDM"},{"code":"300","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Nos Dna/Rna Quant","code_information":[{"code":"32920775","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":441.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hiv 1 Ag W/Hiv 1-2 Abs Direct Obs","code_information":[{"code":"32920779","type":"CDM"},{"code":"300","type":"RC"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Strep Gp A Ag Immunoassay","code_information":[{"code":"32920781","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Strep Scn Poc","code_information":[{"code":"32920782","type":"CDM"},{"code":"300","type":"RC"},{"code":"87880","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Nos Immunoassay","code_information":[{"code":"32920783","type":"CDM"},{"code":"300","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Drug Suscept","code_information":[{"code":"32920784","type":"CDM"},{"code":"300","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":1574.0,"discounted_cash":787.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Genotype-Hiv Rt","code_information":[{"code":"32920785","type":"CDM"},{"code":"300","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hep C Genotype","code_information":[{"code":"32920786","type":"CDM"},{"code":"300","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":3066.0,"discounted_cash":1533.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inf Agent Genotype-Hiv Other","code_information":[{"code":"32920787","type":"CDM"},{"code":"300","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":1546.0,"discounted_cash":773.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytp Urne 3-5 Probes Ea Spec","code_information":[{"code":"32920790","type":"CDM"},{"code":"300","type":"RC"},{"code":"88120","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.0,"discounted_cash":1310.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytopath C/V Interpret","code_information":[{"code":"32920792","type":"CDM"},{"code":"300","type":"RC"},{"code":"88141","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pap-Gyn Surepath","code_information":[{"code":"32920793","type":"CDM"},{"code":"923","type":"RC"},{"code":"88142","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytopath Gyn Auto W/Man Rev","code_information":[{"code":"32920794","type":"CDM"},{"code":"311","type":"RC"},{"code":"88175","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto/ Tc 1 Marker Blood","code_information":[{"code":"32920796","type":"CDM"},{"code":"300","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto/Tc Ea Add Marker Blood","code_information":[{"code":"32920797","type":"CDM"},{"code":"300","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto Interp 16+ Mkrs Blood","code_information":[{"code":"32920799","type":"CDM"},{"code":"300","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mol Cytogen Dna Pb Ea (Fish)","code_information":[{"code":"32920807","type":"CDM"},{"code":"300","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.0,"discounted_cash":211.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mol Cyto Interphase 100-300 Cells","code_information":[{"code":"32920809","type":"CDM"},{"code":"310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chrom Anal Add Karyotypes Ea Study","code_information":[{"code":"32920810","type":"CDM"},{"code":"300","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":95.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Outside Consult 88321","code_information":[{"code":"32920814","type":"CDM"},{"code":"310","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.0,"discounted_cash":151.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ihc  First Ab","code_information":[{"code":"32920815","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunofluor First Stain","code_information":[{"code":"32920816","type":"CDM"},{"code":"300","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":470.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Electron Microscpy Diag","code_information":[{"code":"32920817","type":"CDM"},{"code":"312","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":2341.0,"discounted_cash":1170.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunofluor Added Stain","code_information":[{"code":"32920818","type":"CDM"},{"code":"300","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":470.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ihc Tumor Stain","code_information":[{"code":"32920819","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc In Situ Hybrid Fish Each","code_information":[{"code":"32920820","type":"CDM"},{"code":"300","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.0,"discounted_cash":196.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Morph Anal Multiplex Probe Stain","code_information":[{"code":"32920824","type":"CDM"},{"code":"310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":650.0,"discounted_cash":325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Morph Anal Manual Multiplex","code_information":[{"code":"32920825","type":"CDM"},{"code":"300","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":1512.0,"discounted_cash":756.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bili Check(0-20 Days) Poc","code_information":[{"code":"32920827","type":"CDM"},{"code":"300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bili Check (0-20 Days)Op","code_information":[{"code":"32920828","type":"CDM"},{"code":"300","type":"RC"},{"code":"88720","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cell Count Body Fld","code_information":[{"code":"32920829","type":"CDM"},{"code":"300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cell Count Body Fld W/Diff","code_information":[{"code":"32920830","type":"CDM"},{"code":"300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Crystals Tiss / Body Fld","code_information":[{"code":"32920831","type":"CDM"},{"code":"300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.0,"discounted_cash":25.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sperm Ck Post Vas","code_information":[{"code":"32920833","type":"CDM"},{"code":"300","type":"RC"},{"code":"89321","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.0,"discounted_cash":38.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Liver Dis 10 Assays W/ Nash","code_information":[{"code":"32920835","type":"CDM"},{"code":"300","type":"RC"},{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.0,"discounted_cash":581.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Respiratory Panel","code_information":[{"code":"32920840","type":"CDM"},{"code":"300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":797.0,"discounted_cash":398.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Psa Screening","code_information":[{"code":"32920841","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.0,"discounted_cash":77.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol Industrial","code_information":[{"code":"32920842","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.0,"discounted_cash":72.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Test Def 1-7 Classes","code_information":[{"code":"32920843","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":597.0,"discounted_cash":298.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Scn Definitive 8-14 Classes","code_information":[{"code":"32920844","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"gross_charge":1476.0,"discounted_cash":738.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Screen Dot Coc Collection Only","code_information":[{"code":"32920849","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Draw For Law Enforcement","code_information":[{"code":"32920854","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":28.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcytometry 2-8 Expression","code_information":[{"code":"32920862","type":"CDM"},{"code":"300","type":"RC"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":638.0,"discounted_cash":319.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Infliximab","code_information":[{"code":"32920863","type":"CDM"},{"code":"300","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microbe Susceptible Mic","code_information":[{"code":"32920864","type":"CDM"},{"code":"300","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ehrlichia Antibody","code_information":[{"code":"32920868","type":"CDM"},{"code":"300","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":47.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Covid-19 (Coronavirus) Ag","code_information":[{"code":"32920869","type":"CDM"},{"code":"300","type":"RC"},{"code":"87426","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Adalimumab","code_information":[{"code":"32920870","type":"CDM"},{"code":"300","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Igh Vari Regional Mutation","code_information":[{"code":"32920871","type":"CDM"},{"code":"300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1270.0,"discounted_cash":635.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dna/Rna Amplified Probe","code_information":[{"code":"32920872","type":"CDM"},{"code":"300","type":"RC"},{"code":"87150","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.0,"discounted_cash":206.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Microbe Susceptible Disk, Gp B","code_information":[{"code":"32920873","type":"CDM"},{"code":"300","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":222.0,"discounted_cash":111.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mopath Procedure Level 2","code_information":[{"code":"32920875","type":"CDM"},{"code":"300","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":295.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunoassay Quant Nmo","code_information":[{"code":"32920877","type":"CDM"},{"code":"300","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Heparin Induced Platelet","code_information":[{"code":"32920878","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mitochondrial Antibody Each","code_information":[{"code":"32920879","type":"CDM"},{"code":"300","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.0,"discounted_cash":104.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rbc Dna Gntyp 12 Bld Grp Gen","code_information":[{"code":"32920880","type":"CDM"},{"code":"300","type":"RC"},{"code":"0282U","type":"HCPCS"}],"standard_charges":[{"gross_charge":3965.0,"discounted_cash":1982.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assay Myeloperoxidase","code_information":[{"code":"32920881","type":"CDM"},{"code":"300","type":"RC"},{"code":"83876","type":"HCPCS"}],"standard_charges":[{"gross_charge":377.0,"discounted_cash":188.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ig Light Chains Free Each","code_information":[{"code":"32920882","type":"CDM"},{"code":"300","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.0,"discounted_cash":68.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tp53 Gene Trgt Sequence Alys","code_information":[{"code":"32920883","type":"CDM"},{"code":"300","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1470.0,"discounted_cash":735.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Culture Bacteria Anaerobic","code_information":[{"code":"32920885","type":"CDM"},{"code":"300","type":"RC"},{"code":"87073","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.0,"discounted_cash":68.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluorescent Antibody Screen","code_information":[{"code":"32920887","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Molecular Cytogenetics 10-30","code_information":[{"code":"32920888","type":"CDM"},{"code":"300","type":"RC"},{"code":"88273","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.0,"discounted_cash":95.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ria Nonantibody","code_information":[{"code":"32920889","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":436.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Orthopoxvirus Amp Prb Each","code_information":[{"code":"32920890","type":"CDM"},{"code":"300","type":"RC"},{"code":"87593","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.0,"discounted_cash":248.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Allg Spec Ige Crude Xtrc Ea","code_information":[{"code":"32920891","type":"CDM"},{"code":"300","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":266.0,"discounted_cash":133.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc El-1 Fecal Quantitative","code_information":[{"code":"32920892","type":"CDM"},{"code":"300","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Col Chromotography Qual/Quan","code_information":[{"code":"32920893","type":"CDM"},{"code":"300","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":873.0,"discounted_cash":436.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chromosome Analysis 5","code_information":[{"code":"32920894","type":"CDM"},{"code":"300","type":"RC"},{"code":"88261","type":"HCPCS"}],"standard_charges":[{"gross_charge":1462.0,"discounted_cash":731.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Culture, Blood Cells","code_information":[{"code":"32920895","type":"CDM"},{"code":"300","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":808.0,"discounted_cash":404.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chromosome Count Additional","code_information":[{"code":"32920896","type":"CDM"},{"code":"300","type":"RC"},{"code":"88285","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Platelet Antibody Profile","code_information":[{"code":"32920897","type":"CDM"},{"code":"300","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mycobacteria Identification","code_information":[{"code":"32920898","type":"CDM"},{"code":"300","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.0,"discounted_cash":525.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Ag Donor 4 Rbc Ag (Arc)","code_information":[{"code":"32920899","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":919.0,"discounted_cash":459.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Itraconazole","code_information":[{"code":"32920900","type":"CDM"},{"code":"300","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ugt1A1 Gene Analysis, Common Variants","code_information":[{"code":"32920901","type":"CDM"},{"code":"300","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":470.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluorescent Non-Inf Ab Screen","code_information":[{"code":"32920902","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ria Nonab","code_information":[{"code":"32920903","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":256.0,"discounted_cash":128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mog-Igg1 Antb Cba Each","code_information":[{"code":"32920904","type":"CDM"},{"code":"300","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":2091.0,"discounted_cash":1045.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aquaporin-4 Antb Elisa","code_information":[{"code":"32920905","type":"CDM"},{"code":"300","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":1140.0,"discounted_cash":570.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Voltage-Gtd Ca Chnl Antb Ea","code_information":[{"code":"32920906","type":"CDM"},{"code":"300","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fluorescent Antb Screen","code_information":[{"code":"32920907","type":"CDM"},{"code":"300","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.0,"discounted_cash":113.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Screening Buprenorpine","code_information":[{"code":"32920908","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Opioids & Opiate Analogs 1/2","code_information":[{"code":"32920909","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc General Health Panel","code_information":[{"code":"32920910","type":"CDM"},{"code":"300","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":443.0,"discounted_cash":221.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ria Nonab Musk Ab","code_information":[{"code":"32920911","type":"CDM"},{"code":"300","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":1543.0,"discounted_cash":771.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cbc No Diff Dat","code_information":[{"code":"32920916","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Glucose Quant Blood Dat","code_information":[{"code":"32920917","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hemoglobin A1C Dat","code_information":[{"code":"32920918","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Basic Met Prof Dat","code_information":[{"code":"32920919","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Comprehensive Met Prof Dat","code_information":[{"code":"32920920","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Lipid Profile Dat","code_information":[{"code":"32920923","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hcg Qual Dat","code_information":[{"code":"32920926","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Psa Screening Dat","code_information":[{"code":"32920927","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tsh Dat","code_information":[{"code":"32920928","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":49.0,"discounted_cash":24.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vit D 25-Hydroxy Dat","code_information":[{"code":"32920929","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":34.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Leukocyte Assessment Fecal","code_information":[{"code":"32920933","type":"CDM"},{"code":"300","type":"RC"},{"code":"89055","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.0,"discounted_cash":20.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Alcohol Biomarkers 1 Or 2","code_information":[{"code":"32920934","type":"CDM"},{"code":"300","type":"RC"},{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"gross_charge":515.0,"discounted_cash":257.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iadna-Dna/Rna Probe Tq 6-11","code_information":[{"code":"32920935","type":"CDM"},{"code":"300","type":"RC"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":2901.0,"discounted_cash":1450.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assay Lipoprotein Pla2","code_information":[{"code":"32920936","type":"CDM"},{"code":"300","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":324.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nos Each Organism Ag Ia","code_information":[{"code":"32920937","type":"CDM"},{"code":"300","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":553.0,"discounted_cash":276.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bacterial Vaginosis, Naa Labcorp","code_information":[{"code":"32920938","type":"CDM"},{"code":"300","type":"RC"},{"code":"87999","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.0,"discounted_cash":209.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytogenetics 100-300","code_information":[{"code":"32920939","type":"CDM"},{"code":"300","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pai-1 4G/5G Polymorphism Labcorp","code_information":[{"code":"32920940","type":"CDM"},{"code":"300","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.0,"discounted_cash":195.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Actinomyces Antibody","code_information":[{"code":"32920941","type":"CDM"},{"code":"300","type":"RC"},{"code":"86602","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Actin Antibody Each","code_information":[{"code":"32920942","type":"CDM"},{"code":"300","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anca Titer Each Antibody","code_information":[{"code":"32920943","type":"CDM"},{"code":"300","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tiss Transfltmnase Ea Ig Class","code_information":[{"code":"32920944","type":"CDM"},{"code":"300","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ema Each Ig Class","code_information":[{"code":"32920945","type":"CDM"},{"code":"300","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dgp Antibody Each Ig Class","code_information":[{"code":"32920946","type":"CDM"},{"code":"300","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.0,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bkv Quant Pcr Labcorp","code_information":[{"code":"32920949","type":"CDM"},{"code":"300","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":441.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nfct Ds 22 Trgt Sars-Cov-2","code_information":[{"code":"32920951","type":"CDM"},{"code":"300","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2255.0,"discounted_cash":1127.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hcg Qual Urine Dat","code_information":[{"code":"32920953","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":39.0,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assay Of Volatiles","code_information":[{"code":"32920955","type":"CDM"},{"code":"300","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":144.0,"discounted_cash":72.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Igvh Somatic Hypermutation Lc","code_information":[{"code":"32920956","type":"CDM"},{"code":"300","type":"RC"},{"code":"81263","type":"HCPCS"}],"standard_charges":[{"gross_charge":1420.0,"discounted_cash":710.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Laboratory","code_information":[{"code":"32920957","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":512.56,"discounted_cash":256.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Assay Carboxyhb Quant","code_information":[{"code":"32920958","type":"CDM"},{"code":"300","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vistaseq Apc Comp Analysis; Gene Full Sequence Lc","code_information":[{"code":"32920960","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":3740.0,"discounted_cash":1870.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Vistaseq Apc Comp Analysis; Gene Dup/Delet Variants Lc","code_information":[{"code":"32920961","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.0,"discounted_cash":480.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acetylcholn Rcptr Blckg Antb","code_information":[{"code":"32920962","type":"CDM"},{"code":"300","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Acetylcholn Rcptr Modlg Antb","code_information":[{"code":"32920963","type":"CDM"},{"code":"300","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.0,"discounted_cash":93.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assay Anti-Mullerian Horm","code_information":[{"code":"32920964","type":"CDM"},{"code":"300","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.0,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Muscle-Specific Kinase Antb","code_information":[{"code":"32920965","type":"CDM"},{"code":"300","type":"RC"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Jak2 V617F Mutation Analysis Qual Labcorp","code_information":[{"code":"32920966","type":"CDM"},{"code":"300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":480.0,"discounted_cash":240.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ugt1A1 Irinotecan Toxicity Labcorp","code_information":[{"code":"32920967","type":"CDM"},{"code":"300","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1120.0,"discounted_cash":560.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dpyd Genotyping Labcorp","code_information":[{"code":"32920968","type":"CDM"},{"code":"300","type":"RC"},{"code":"81232","type":"HCPCS"}],"standard_charges":[{"gross_charge":930.0,"discounted_cash":465.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drug Assay Methotrexate","code_information":[{"code":"32920970","type":"CDM"},{"code":"300","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":469.0,"discounted_cash":234.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Znt8 Antibody","code_information":[{"code":"32920971","type":"CDM"},{"code":"300","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.0,"discounted_cash":364.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hla Class I High Defin Qual","code_information":[{"code":"32920972","type":"CDM"},{"code":"300","type":"RC"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":2647.0,"discounted_cash":1323.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hla Class Ii Antibody Identification","code_information":[{"code":"32920973","type":"CDM"},{"code":"300","type":"RC"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":2665.0,"discounted_cash":1332.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pml/Raralpha Apl Quant Labcorp","code_information":[{"code":"32920974","type":"CDM"},{"code":"300","type":"RC"},{"code":"81315","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Iadna Multiple Organisms Amplified Probe Tq","code_information":[{"code":"32920976","type":"CDM"},{"code":"300","type":"RC"},{"code":"87801","type":"HCPCS"}],"standard_charges":[{"gross_charge":937.0,"discounted_cash":468.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hbb Gene Com Variants Sickle Cell","code_information":[{"code":"32920977","type":"CDM"},{"code":"300","type":"RC"},{"code":"81361","type":"HCPCS"}],"standard_charges":[{"gross_charge":840.0,"discounted_cash":420.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Specimen Handling","code_information":[{"code":"32920978","type":"CDM"},{"code":"300","type":"RC"},{"code":"DAKIT","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":15.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Strptcs Pneum Antb Serot Ia","code_information":[{"code":"32920983","type":"CDM"},{"code":"300","type":"RC"},{"code":"86581","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.0,"discounted_cash":76.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Assay Of Interleukin-6","code_information":[{"code":"32920984","type":"CDM"},{"code":"300","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.0,"discounted_cash":42.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Spinal Muscular Atrophy (Sma) Labcorp","code_information":[{"code":"32920985","type":"CDM"},{"code":"300","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":536.0,"discounted_cash":268.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anca Screen Each Antibody","code_information":[{"code":"32920986","type":"CDM"},{"code":"300","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":158.0,"discounted_cash":79.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mpn Core Diagnostic Panel Quest","code_information":[{"code":"32920987","type":"CDM"},{"code":"300","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1170.0,"discounted_cash":585.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Protein Western Blot Test","code_information":[{"code":"32920988","type":"CDM"},{"code":"300","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Aquaporin-4 Antb Cba Each","code_information":[{"code":"32920989","type":"CDM"},{"code":"300","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":294.0,"discounted_cash":147.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fetal Maternal Hemorrhage, Hgb (Kleihauer-Betke)","code_information":[{"code":"33020001","type":"CDM"},{"code":"300","type":"RC"},{"code":"85460","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.0,"discounted_cash":191.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Fetal Maternal Hemorrhage Rosette","code_information":[{"code":"33020002","type":"CDM"},{"code":"300","type":"RC"},{"code":"85461","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":61.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ab Screen Rbc (Ind Coombs)","code_information":[{"code":"33020003","type":"CDM"},{"code":"300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.0,"discounted_cash":35.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ab Elution Rbc Each","code_information":[{"code":"33020004","type":"CDM"},{"code":"300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":223.0,"discounted_cash":111.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Antibody Id Ea Panel","code_information":[{"code":"33020005","type":"CDM"},{"code":"300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":954.0,"discounted_cash":477.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ahg Direct Each","code_information":[{"code":"33020006","type":"CDM"},{"code":"300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Abo","code_information":[{"code":"33020008","type":"CDM"},{"code":"300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Rh","code_information":[{"code":"33020009","type":"CDM"},{"code":"300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ag Scn Donor Bld Each Ag (Arc)","code_information":[{"code":"33020010","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":236.0,"discounted_cash":118.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ag Scn Rbc Ag Each","code_information":[{"code":"33020011","type":"CDM"},{"code":"300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Compatibility Ahg","code_information":[{"code":"33020012","type":"CDM"},{"code":"300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.0,"discounted_cash":123.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Compatibility Electronic","code_information":[{"code":"33020013","type":"CDM"},{"code":"300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":671.0,"discounted_cash":335.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ffp Thawing Ea Unit","code_information":[{"code":"33020014","type":"CDM"},{"code":"300","type":"RC"},{"code":"86927","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rbc Serum Pretx Id Dilution (Arc)","code_information":[{"code":"33020015","type":"CDM"},{"code":"300","type":"RC"},{"code":"86976","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":47.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc-Rbc Lr","code_information":[{"code":"33020016","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":412.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc Pher Plt Lr","code_information":[{"code":"33020019","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":2430.0,"discounted_cash":1215.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc Pher Plt Lr Irr","code_information":[{"code":"33020020","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9037","type":"HCPCS"}],"standard_charges":[{"gross_charge":2652.0,"discounted_cash":1326.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc Rbc Lr Irr","code_information":[{"code":"33020021","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":978.0,"discounted_cash":489.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc-Fp (8-24Hr)","code_information":[{"code":"33020022","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.0,"discounted_cash":106.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Arc Pher Plt Path Redu","code_information":[{"code":"33020023","type":"CDM"},{"code":"390","type":"RC"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":2722.0,"discounted_cash":1361.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Ag Donor 2 Rbc Ag (Arc)","code_information":[{"code":"33020024","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.0,"discounted_cash":200.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Ag Donor 3 Rbc Ag (Arc)","code_information":[{"code":"33020025","type":"CDM"},{"code":"300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":636.0,"discounted_cash":318.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Abo Dat","code_information":[{"code":"33020028","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":9.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Type Rh Dat","code_information":[{"code":"33020029","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":9.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rhce Variants, Snp Array (Arc)","code_information":[{"code":"33020030","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":810.0,"discounted_cash":405.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sanger Sequencing, 6-10 Exons Jk (Arc)","code_information":[{"code":"33020031","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":350.0,"discounted_cash":175.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Multiplex Jk C. 130 Ssp-Pcr (Arc)","code_information":[{"code":"33020032","type":"CDM"},{"code":"300","type":"RC"},{"code":"81403","type":"HCPCS"}],"standard_charges":[{"gross_charge":1180.0,"discounted_cash":590.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Blood Bank","code_information":[{"code":"33020033","type":"CDM"},{"code":"300","type":"RC"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":152.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc 88104 Cytopath Fld Wash Brush Smr W/Int","code_information":[{"code":"33120001","type":"CDM"},{"code":"311","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":75.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88108 Cytopath Conc Tech Smr/Interp","code_information":[{"code":"33120002","type":"CDM"},{"code":"311","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytopath Cell Enhance Tech W/Interp","code_information":[{"code":"33120003","type":"CDM"},{"code":"311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88173 Fna Interp / Rpt","code_information":[{"code":"33120006","type":"CDM"},{"code":"311","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto/Tc 1 Marker Path","code_information":[{"code":"33120007","type":"CDM"},{"code":"310","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1411.0,"discounted_cash":705.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto/Tc Ea Add Marker Path","code_information":[{"code":"33120008","type":"CDM"},{"code":"310","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto Interp 2-8 Mkrs Path","code_information":[{"code":"33120009","type":"CDM"},{"code":"310","type":"RC"},{"code":"88187","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.0,"discounted_cash":106.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcyto Interp 16+ Mkrs Path","code_information":[{"code":"33120010","type":"CDM"},{"code":"310","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":325.0,"discounted_cash":162.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88300 Level I Gross","code_information":[{"code":"33120011","type":"CDM"},{"code":"310","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.0,"discounted_cash":39.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88302 Level Ii Tissue","code_information":[{"code":"33120012","type":"CDM"},{"code":"310","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88304 Level Iii Tissue","code_information":[{"code":"33120013","type":"CDM"},{"code":"310","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88305 Level Iv Tissue","code_information":[{"code":"33120014","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88307 Level V Tissue","code_information":[{"code":"33120015","type":"CDM"},{"code":"310","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":907.0,"discounted_cash":453.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88309 Level Vi Tissue","code_information":[{"code":"33120016","type":"CDM"},{"code":"310","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":1266.0,"discounted_cash":633.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88311 Decalc Proc","code_information":[{"code":"33120017","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":33.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88312 Spec Stn Gp 1 Micro","code_information":[{"code":"33120018","type":"CDM"},{"code":"310","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":123.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88313 Spec Stn Gp 2","code_information":[{"code":"33120019","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":168.0,"discounted_cash":84.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Consult With Slide Prep","code_information":[{"code":"33120021","type":"CDM"},{"code":"310","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":246.0,"discounted_cash":123.0,"setting":"both","modifiers":"XP","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier XP: Separate practitioner, a service that is distinct because it was performed by a different practitioner"}]},{"description":"Hc Consult, Comprehensive","code_information":[{"code":"33120022","type":"CDM"},{"code":"310","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":717.0,"discounted_cash":358.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88331 Froz Sect First Blk","code_information":[{"code":"33120024","type":"CDM"},{"code":"310","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":728.0,"discounted_cash":364.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88332 Froz Sect Ea Add Blk","code_information":[{"code":"33120025","type":"CDM"},{"code":"310","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.0,"discounted_cash":61.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88333 Touch Prep Initial Site","code_information":[{"code":"33120026","type":"CDM"},{"code":"310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":3147.0,"discounted_cash":1573.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88334 Touch Prep Ea Added","code_information":[{"code":"33120027","type":"CDM"},{"code":"310","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ihc Add Ab","code_information":[{"code":"33120028","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.0,"discounted_cash":134.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ihc Multiplex Ab Stain","code_information":[{"code":"33120029","type":"CDM"},{"code":"310","type":"RC"},{"code":"88344","type":"HCPCS"}],"standard_charges":[{"gross_charge":1456.0,"discounted_cash":728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tumor Immunohistochem/Comput","code_information":[{"code":"33120032","type":"CDM"},{"code":"310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":1434.0,"discounted_cash":717.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc M/Phmtrc Alys Ishquant/Semiq","code_information":[{"code":"33120033","type":"CDM"},{"code":"310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.0,"discounted_cash":369.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Mopath Procedure Level 1A","code_information":[{"code":"33120037","type":"CDM"},{"code":"310","type":"RC"},{"code":"81400","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flow Maker, First Lc Bm","code_information":[{"code":"33120038","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flow Marker, Each Additional Lc Bm","code_information":[{"code":"33120039","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":45.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tissue Culture Bone Marrow Lc Bm","code_information":[{"code":"33120040","type":"CDM"},{"code":"311","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":371.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Decalcify Tissue Tc, Each Lc Bm","code_information":[{"code":"33120042","type":"CDM"},{"code":"310","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.0,"discounted_cash":17.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunohisto Antb First Stain Tc Lc Bm","code_information":[{"code":"33120043","type":"CDM"},{"code":"310","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":280.0,"discounted_cash":140.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Sp Stain Gr Ii Tc, Each Lc Bm","code_information":[{"code":"33120044","type":"CDM"},{"code":"310","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.0,"discounted_cash":145.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Surg Path L Iv, Each Tc Lc Bm","code_information":[{"code":"33120045","type":"CDM"},{"code":"310","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.0,"discounted_cash":73.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bone Marrow Interp & Report Lc Bm","code_information":[{"code":"33120046","type":"CDM"},{"code":"305","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":545.0,"discounted_cash":272.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Immunohisto Antb Addl Stain Tc, Each Lc Bm","code_information":[{"code":"33120047","type":"CDM"},{"code":"310","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.0,"discounted_cash":129.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Chromosome Analysis 20-25 Lc Bm","code_information":[{"code":"33120048","type":"CDM"},{"code":"311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":743.0,"discounted_cash":371.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytogenetics Dna Probe, Each Lc Bm","code_information":[{"code":"33120049","type":"CDM"},{"code":"311","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.0,"discounted_cash":64.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cytogenetics 100-300 Lc Bm","code_information":[{"code":"33120050","type":"CDM"},{"code":"311","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":135.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insitu Hybridization Fish Initial","code_information":[{"code":"33120051","type":"CDM"},{"code":"310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":706.0,"discounted_cash":353.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Insitu Hybridization Fish Each Addl","code_information":[{"code":"33120052","type":"CDM"},{"code":"310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":414.0,"discounted_cash":207.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ccnd1/Igh Translocation Alys Neo","code_information":[{"code":"33120053","type":"CDM"},{"code":"310","type":"RC"},{"code":"81168","type":"HCPCS"}],"standard_charges":[{"gross_charge":830.0,"discounted_cash":415.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc B-Cell (Igh, Igk) Gene Rearrangement Mc Neogenomics","code_information":[{"code":"33120056","type":"CDM"},{"code":"310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":1490.0,"discounted_cash":745.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Her2 Ihc Stain Pkvw","code_information":[{"code":"33120071","type":"CDM"},{"code":"310","type":"RC"},{"code":"88368","type":"HCPCS"}],"standard_charges":[{"gross_charge":1210.0,"discounted_cash":605.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Her 2 Fish Pkvw","code_information":[{"code":"33120072","type":"CDM"},{"code":"310","type":"RC"},{"code":"88369","type":"HCPCS"}],"standard_charges":[{"gross_charge":690.0,"discounted_cash":345.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcytometry/ Tc 1 Marker Lymphoma Panel Pkvw","code_information":[{"code":"33120073","type":"CDM"},{"code":"311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.0,"discounted_cash":555.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Flowcytometry/Tc Add-On Lymphoma Panel Pkvw","code_information":[{"code":"33120074","type":"CDM"},{"code":"311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.0,"discounted_cash":190.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Pole Mutation Analysis Mayo","code_information":[{"code":"33120075","type":"CDM"},{"code":"310","type":"RC"},{"code":"88381","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Anatomical Pathology","code_information":[{"code":"33120076","type":"CDM"},{"code":"310","type":"RC"}],"standard_charges":[{"gross_charge":483.44,"discounted_cash":241.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Intelligen(R) Myeloid Lc Bm","code_information":[{"code":"33120077","type":"CDM"},{"code":"310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":8820.0,"discounted_cash":4410.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc P53 Mutation Analysis Lc Bm","code_information":[{"code":"33120078","type":"CDM"},{"code":"310","type":"RC"},{"code":"81352","type":"HCPCS"}],"standard_charges":[{"gross_charge":1720.0,"discounted_cash":860.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc 88313 Tissue Stain To Neogenomics Pkvw","code_information":[{"code":"33120079","type":"CDM"},{"code":"312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tumor Immunohistochem/Manual Lc Bm","code_information":[{"code":"33120080","type":"CDM"},{"code":"310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.0,"discounted_cash":234.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Myd88 Mutation Detection Pcr Lc Bm","code_information":[{"code":"33120081","type":"CDM"},{"code":"310","type":"RC"},{"code":"81305","type":"HCPCS"}],"standard_charges":[{"gross_charge":770.0,"discounted_cash":385.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Tendon/Ligament/Cyst","code_information":[{"code":"43976668","type":"CDM"},{"code":"761","type":"RC"},{"code":"20550","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Trigger Point 1-2 Mus Group","code_information":[{"code":"43976671","type":"CDM"},{"code":"761","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Trigger Point 1-2 Mus Group Clinic","code_information":[{"code":"43976672","type":"CDM"},{"code":"761","type":"RC"},{"code":"20552","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Trigger Pnt 3 Or More Grps","code_information":[{"code":"43976673","type":"CDM"},{"code":"761","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Trigger Pnt 3 Or More Grps Clinic","code_information":[{"code":"43976674","type":"CDM"},{"code":"761","type":"RC"},{"code":"20553","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Sm","code_information":[{"code":"43976675","type":"CDM"},{"code":"761","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Sm Clinic","code_information":[{"code":"43976676","type":"CDM"},{"code":"761","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Med","code_information":[{"code":"43976677","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Med Clinic","code_information":[{"code":"43976678","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Slg","code_information":[{"code":"43976679","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Bilateral","code_information":[{"code":"43976680","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lt Lg Clinic","code_information":[{"code":"43976681","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Lg Bil Clinic","code_information":[{"code":"43976682","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Injection Sacroiliac Joint Lt","code_information":[{"code":"43976686","type":"CDM"},{"code":"761","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Injection Sacroliac Joint Bilateral","code_information":[{"code":"43976687","type":"CDM"},{"code":"761","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":2239.0,"discounted_cash":1119.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Inject Spine L/S (Cd)","code_information":[{"code":"43976702","type":"CDM"},{"code":"761","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Ip Neeuroelec (Leads)","code_information":[{"code":"43976704","type":"CDM"},{"code":"761","type":"RC"},{"code":"63650","type":"HCPCS"}],"standard_charges":[{"gross_charge":16891.0,"discounted_cash":8445.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Implant Neuroreciever Stimultr","code_information":[{"code":"43976707","type":"CDM"},{"code":"761","type":"RC"},{"code":"63685","type":"HCPCS"}],"standard_charges":[{"gross_charge":80694.0,"discounted_cash":40347.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Revise/Remove Neuroreciever","code_information":[{"code":"43976708","type":"CDM"},{"code":"761","type":"RC"},{"code":"63688","type":"HCPCS"}],"standard_charges":[{"gross_charge":9456.0,"discounted_cash":4728.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Trigeminal Lt","code_information":[{"code":"43976709","type":"CDM"},{"code":"761","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Trigemnal Lt Clinic","code_information":[{"code":"43976711","type":"CDM"},{"code":"761","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Occipital Lt","code_information":[{"code":"43976713","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Occipital Bilat","code_information":[{"code":"43976714","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Occipital Lt Clinic","code_information":[{"code":"43976715","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Occipital Bil Clinic","code_information":[{"code":"43976716","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Axillary Lt","code_information":[{"code":"43976718","type":"CDM"},{"code":"761","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Suprascapular Lt","code_information":[{"code":"43976719","type":"CDM"},{"code":"761","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Blk Suprascapular Bil","code_information":[{"code":"43976720","type":"CDM"},{"code":"761","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Intercost Sngl Lt","code_information":[{"code":"43976722","type":"CDM"},{"code":"761","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Intercost Lt Ea Addnl","code_information":[{"code":"43976724","type":"CDM"},{"code":"761","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Pudendal Bilateral","code_information":[{"code":"43976729","type":"CDM"},{"code":"761","type":"RC"},{"code":"64430","type":"HCPCS"}],"standard_charges":[{"gross_charge":2710.0,"discounted_cash":1355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Sciatic Lt","code_information":[{"code":"43976730","type":"CDM"},{"code":"761","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nrv Block Inj Sciatic Bilat","code_information":[{"code":"43976731","type":"CDM"},{"code":"761","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Other Peripheral Lt","code_information":[{"code":"43976733","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Oth Periph Bilat","code_information":[{"code":"43976734","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Other Peripherl Bil Clinic","code_information":[{"code":"43976735","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1980.0,"discounted_cash":990.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Other Peripheral Lt Clinic","code_information":[{"code":"43976736","type":"CDM"},{"code":"761","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nrv Block Sacroiliac Jt W/Img Guid Bilat","code_information":[{"code":"43976737","type":"CDM"},{"code":"761","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1961.0,"discounted_cash":980.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nrv Block Sacroiliac Jt Lt W/Image Guidance","code_information":[{"code":"43976738","type":"CDM"},{"code":"761","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Genicular Lt W/Image Guidance","code_information":[{"code":"43976739","type":"CDM"},{"code":"761","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Genicular W/Img Guid Bilat","code_information":[{"code":"43976740","type":"CDM"},{"code":"761","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1986.0,"discounted_cash":993.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj C/T Lt","code_information":[{"code":"43976741","type":"CDM"},{"code":"761","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epid Inj C/T Bilt","code_information":[{"code":"43976742","type":"CDM"},{"code":"761","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj C/T Lt Add On","code_information":[{"code":"43976743","type":"CDM"},{"code":"761","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj L/S Lt","code_information":[{"code":"43976745","type":"CDM"},{"code":"761","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epid Inj L/S Bilat","code_information":[{"code":"43976746","type":"CDM"},{"code":"761","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epid Inj L/S Lt Add On","code_information":[{"code":"43976747","type":"CDM"},{"code":"761","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral C/T Facet Lt","code_information":[{"code":"43976750","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral C/T Facet Bil","code_information":[{"code":"43976751","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral C/T Facet Lt 2Nd Level","code_information":[{"code":"43976752","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":873.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc C/T Pv Facet Lt 3Rd And Add Level","code_information":[{"code":"43976755","type":"CDM"},{"code":"761","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral L/S Facet Bilateral","code_information":[{"code":"43976756","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral L/S Facet Lt","code_information":[{"code":"43976757","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral L/S Facet Lt 2Nd Level","code_information":[{"code":"43976758","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Stellate Ganglion Lt","code_information":[{"code":"43976764","type":"CDM"},{"code":"761","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Hypogastric Plexus Block","code_information":[{"code":"43976765","type":"CDM"},{"code":"761","type":"RC"},{"code":"64517","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Lumb/Thoracic Lt","code_information":[{"code":"43976766","type":"CDM"},{"code":"761","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Blk Lumb/Thoracic Bilat","code_information":[{"code":"43976767","type":"CDM"},{"code":"761","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":1287.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Celiac Pelus","code_information":[{"code":"43976768","type":"CDM"},{"code":"761","type":"RC"},{"code":"64530","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Dest Nerve Face, Trig, C Spine, Bil Migr","code_information":[{"code":"43976771","type":"CDM"},{"code":"761","type":"RC"},{"code":"64615","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.0,"discounted_cash":409.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr W Neurolyt Intercost Nrv","code_information":[{"code":"43976774","type":"CDM"},{"code":"761","type":"RC"},{"code":"64620","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr W Neurolyt Genicular Lt Nerve W Image","code_information":[{"code":"43976775","type":"CDM"},{"code":"761","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Sacroiliac Nrv Rf Ablation Lt W Image","code_information":[{"code":"43976777","type":"CDM"},{"code":"761","type":"RC"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral Nerve C.T Lt","code_information":[{"code":"43976779","type":"CDM"},{"code":"761","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4814.0,"discounted_cash":2407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Bil Destr Paravetebral Nerve C/T","code_information":[{"code":"43976780","type":"CDM"},{"code":"761","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":6023.0,"discounted_cash":3011.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral N C/T Lt Add","code_information":[{"code":"43976781","type":"CDM"},{"code":"761","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1455.0,"discounted_cash":727.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destroy Paravertebral Nrv Lt L/S","code_information":[{"code":"43976783","type":"CDM"},{"code":"761","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4814.0,"discounted_cash":2407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destroy Paravert Nrvs L/S Bil","code_information":[{"code":"43976784","type":"CDM"},{"code":"761","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":5910.0,"discounted_cash":2955.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral Lt N Add-On","code_information":[{"code":"43976785","type":"CDM"},{"code":"761","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.0,"discounted_cash":963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neurolysis Other Peripheral Lt Nerve","code_information":[{"code":"43976787","type":"CDM"},{"code":"761","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neurolysis Other Peripheral Nerve Bil","code_information":[{"code":"43976788","type":"CDM"},{"code":"761","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":1287.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx C/T Pv Facet Lt 3Rd And Add Level","code_information":[{"code":"43976814","type":"CDM"},{"code":"761","type":"RC"},{"code":"64492","type":"HCPCS"}],"standard_charges":[{"gross_charge":1832.0,"discounted_cash":916.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral C/T Facet Lt","code_information":[{"code":"43976816","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral C/T Facet Lt 2Nd Level","code_information":[{"code":"43976817","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":873.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral C/T Facet Bil","code_information":[{"code":"43976818","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral L/S Facet Lt","code_information":[{"code":"43976819","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral L/S Facet Lt 2Nd Level","code_information":[{"code":"43976820","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral L/S Facet Bilateral","code_information":[{"code":"43976821","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2538.0,"discounted_cash":1269.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Rt Sm Clinic","code_information":[{"code":"43976824","type":"CDM"},{"code":"761","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Bil Sm Clinic","code_information":[{"code":"43976825","type":"CDM"},{"code":"761","type":"RC"},{"code":"20600","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.0,"discounted_cash":414.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Rt Med","code_information":[{"code":"43976826","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Rt Med Clinic","code_information":[{"code":"43976828","type":"CDM"},{"code":"761","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Rt Lg Clinic","code_information":[{"code":"43976830","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Drain/Inject Joint/Bursa Rt Slg","code_information":[{"code":"43976831","type":"CDM"},{"code":"761","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Injection Sacroiliac Joint Rt","code_information":[{"code":"43976832","type":"CDM"},{"code":"761","type":"RC"},{"code":"27096","type":"HCPCS"}],"standard_charges":[{"gross_charge":1822.0,"discounted_cash":911.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Occipital Rt Clinic","code_information":[{"code":"43976836","type":"CDM"},{"code":"761","type":"RC"},{"code":"64405","type":"HCPCS"}],"standard_charges":[{"gross_charge":659.0,"discounted_cash":329.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Axillary Rt","code_information":[{"code":"43976838","type":"CDM"},{"code":"761","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Axillary Bil","code_information":[{"code":"43976840","type":"CDM"},{"code":"761","type":"RC"},{"code":"64417","type":"HCPCS"}],"standard_charges":[{"gross_charge":2575.0,"discounted_cash":1287.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Suprascapular Rt","code_information":[{"code":"43976841","type":"CDM"},{"code":"761","type":"RC"},{"code":"64418","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Intercost Sngl Rt","code_information":[{"code":"43976844","type":"CDM"},{"code":"761","type":"RC"},{"code":"64420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Intercost Rt Ea Addnl","code_information":[{"code":"43976845","type":"CDM"},{"code":"761","type":"RC"},{"code":"64421","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Inj Sciatic Rt","code_information":[{"code":"43976848","type":"CDM"},{"code":"761","type":"RC"},{"code":"64445","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nrv Block Sacroiliac Jt Rt W/Image Guidance","code_information":[{"code":"43976852","type":"CDM"},{"code":"761","type":"RC"},{"code":"64451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Genicular Rt W/Image Guidance","code_information":[{"code":"43976853","type":"CDM"},{"code":"761","type":"RC"},{"code":"64454","type":"HCPCS"}],"standard_charges":[{"gross_charge":1589.0,"discounted_cash":794.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj C/T Rt","code_information":[{"code":"43976854","type":"CDM"},{"code":"761","type":"RC"},{"code":"64479","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj C/T Rt Add On","code_information":[{"code":"43976855","type":"CDM"},{"code":"761","type":"RC"},{"code":"64480","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epidural Inj L/S Rt","code_information":[{"code":"43976856","type":"CDM"},{"code":"761","type":"RC"},{"code":"64483","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Foramen Epid Inj L/S Rt Add On","code_information":[{"code":"43976857","type":"CDM"},{"code":"761","type":"RC"},{"code":"64484","type":"HCPCS"}],"standard_charges":[{"gross_charge":781.0,"discounted_cash":390.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral C/T Facet Rt","code_information":[{"code":"43976858","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral C/T Facet Rt","code_information":[{"code":"43976859","type":"CDM"},{"code":"761","type":"RC"},{"code":"64490","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral C/T Facet Rt 2Nd Level","code_information":[{"code":"43976860","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":873.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral C/T Facet Rt 2Nd Level","code_information":[{"code":"43976861","type":"CDM"},{"code":"761","type":"RC"},{"code":"64491","type":"HCPCS"}],"standard_charges":[{"gross_charge":1747.0,"discounted_cash":873.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral L/S Facet Rt","code_information":[{"code":"43976864","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral L/S Facet Rt","code_information":[{"code":"43976865","type":"CDM"},{"code":"761","type":"RC"},{"code":"64493","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx Paravertebral L/S Facet Rt 2Nd Level","code_information":[{"code":"43976866","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Paravertebral L/S Facet Rt 2Nd Level","code_information":[{"code":"43976867","type":"CDM"},{"code":"761","type":"RC"},{"code":"64494","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Kx L/S Pv Facet Rt 3Rd And Add Level","code_information":[{"code":"43976868","type":"CDM"},{"code":"761","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc L/S Pv Facet Rt 3Rd And Add Level","code_information":[{"code":"43976869","type":"CDM"},{"code":"761","type":"RC"},{"code":"64495","type":"HCPCS"}],"standard_charges":[{"gross_charge":530.0,"discounted_cash":265.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Stellate Ganglion Rt","code_information":[{"code":"43976871","type":"CDM"},{"code":"761","type":"RC"},{"code":"64510","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Nerve Block Lumb/Thoracic Rt","code_information":[{"code":"43976873","type":"CDM"},{"code":"761","type":"RC"},{"code":"64520","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr W Neurolyt Genicular Rt Nerve W Image","code_information":[{"code":"43976875","type":"CDM"},{"code":"761","type":"RC"},{"code":"64624","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Sacroiliac Nrv Rf Ablation Rt W Image","code_information":[{"code":"43976877","type":"CDM"},{"code":"761","type":"RC"},{"code":"64625","type":"HCPCS"}],"standard_charges":[{"gross_charge":4368.0,"discounted_cash":2184.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral Nerve C.T Rt","code_information":[{"code":"43976878","type":"CDM"},{"code":"761","type":"RC"},{"code":"64633","type":"HCPCS"}],"standard_charges":[{"gross_charge":4814.0,"discounted_cash":2407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral N C/T Rt Add","code_information":[{"code":"43976879","type":"CDM"},{"code":"761","type":"RC"},{"code":"64634","type":"HCPCS"}],"standard_charges":[{"gross_charge":1455.0,"discounted_cash":727.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destroy Paravertebral Nrv Rt L/S","code_information":[{"code":"43976880","type":"CDM"},{"code":"761","type":"RC"},{"code":"64635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4814.0,"discounted_cash":2407.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Destr Paravertebral Rt N Add-On","code_information":[{"code":"43976881","type":"CDM"},{"code":"761","type":"RC"},{"code":"64636","type":"HCPCS"}],"standard_charges":[{"gross_charge":1926.0,"discounted_cash":963.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Neurolysis Other Peripheral Rt Nerve","code_information":[{"code":"43976882","type":"CDM"},{"code":"761","type":"RC"},{"code":"64640","type":"HCPCS"}],"standard_charges":[{"gross_charge":2054.0,"discounted_cash":1027.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Tap Block Unil By Injection Lt","code_information":[{"code":"43976886","type":"CDM"},{"code":"761","type":"RC"},{"code":"64486","type":"HCPCS"}],"standard_charges":[{"gross_charge":1394.0,"discounted_cash":697.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit New Tech","code_information":[{"code":"46199202","type":"CDM"},{"code":"510","type":"RC"},{"code":"99202","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.0,"discounted_cash":26.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit New Tech","code_information":[{"code":"46199203","type":"CDM"},{"code":"510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit New Tech","code_information":[{"code":"46199204","type":"CDM"},{"code":"510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.0,"discounted_cash":53.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit New Tech","code_information":[{"code":"46199205","type":"CDM"},{"code":"510","type":"RC"},{"code":"99205","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.0,"discounted_cash":70.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit Est Tech","code_information":[{"code":"46199211","type":"CDM"},{"code":"510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.0,"discounted_cash":31.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit Est Tech","code_information":[{"code":"46199212","type":"CDM"},{"code":"510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.0,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit Est Tech","code_information":[{"code":"46199213","type":"CDM"},{"code":"510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit Est Tech","code_information":[{"code":"46199214","type":"CDM"},{"code":"510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office/Outpatient Visit Est Tech","code_information":[{"code":"46199215","type":"CDM"},{"code":"510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.0,"discounted_cash":47.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office Consultation Tech","code_information":[{"code":"46199242","type":"CDM"},{"code":"510","type":"RC"},{"code":"99242","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.0,"discounted_cash":51.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office Consultation Tech","code_information":[{"code":"46199243","type":"CDM"},{"code":"510","type":"RC"},{"code":"99243","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.0,"discounted_cash":64.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office Consultation Tech","code_information":[{"code":"46199244","type":"CDM"},{"code":"510","type":"RC"},{"code":"99244","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.0,"discounted_cash":65.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Office Consultation Tech","code_information":[{"code":"46199245","type":"CDM"},{"code":"510","type":"RC"},{"code":"99245","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.0,"discounted_cash":89.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_0019NO6800","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9560","type":"HCPCS"}],"standard_charges":[{"gross_charge":258.9,"discounted_cash":129.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_0270008320","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.04,"discounted_cash":63.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_1715602405","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9502","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_1715620105","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.8,"discounted_cash":108.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_4556704551","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9537","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.0,"discounted_cash":105.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_4556706551","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9562","type":"HCPCS"}],"standard_charges":[{"gross_charge":982.56,"discounted_cash":491.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_4881510021","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9516","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.75,"discounted_cash":180.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6517417905","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":58.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6517427020","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9540","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.63,"discounted_cash":29.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6517428830","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9567","type":"HCPCS"}],"standard_charges":[{"gross_charge":1188.52,"discounted_cash":594.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6517466030","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9503","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.3,"discounted_cash":57.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6585715030","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9552","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.0,"discounted_cash":210.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_6585760020","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9500","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.0,"discounted_cash":76.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Rx 343 W Hcpcs","code_information":[{"code":"61300014_9999995566","type":"CDM"},{"code":"343","type":"RC"},{"code":"A9541","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.99,"discounted_cash":102.00,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"77702244_3582851","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":474.4,"discounted_cash":237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"77707126_3585036","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":3467.0,"discounted_cash":1733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"77707487_3586289","type":"CDM"},{"code":"278","type":"RC"},{"code":"B4087","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.9,"discounted_cash":277.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Noncdm Charge Record Medical Supplies","code_information":[{"code":"77708021_3584958","type":"CDM"},{"code":"278","type":"RC"},{"code":"C1713","type":"HCPCS"}],"standard_charges":[{"gross_charge":3467.0,"discounted_cash":1733.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Bone-Prep","code_information":[{"code":"83303962_37589","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":742.38,"discounted_cash":371.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hc Kit Bone-Prep","code_information":[{"code":"83303962","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":755.7,"discounted_cash":377.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Cable And Sleeve Bead","code_information":[{"code":"83303983","type":"CDM"},{"code":"272","type":"RC"}],"standard_charges":[{"gross_charge":2718.76,"discounted_cash":1359.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard"}]},{"description":"Hc Level I","code_information":[{"code":"92200001","type":"CDM"},{"code":"981","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.0,"discounted_cash":45.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Level Ii","code_information":[{"code":"92200002","type":"CDM"},{"code":"981","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":65.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Level Iii","code_information":[{"code":"92200003","type":"CDM"},{"code":"981","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Level Iv","code_information":[{"code":"92200004","type":"CDM"},{"code":"981","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1041.0,"discounted_cash":520.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Level V","code_information":[{"code":"92200005","type":"CDM"},{"code":"981","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":1676.0,"discounted_cash":838.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 0-2.5","code_information":[{"code":"92200009","type":"CDM"},{"code":"981","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.0,"discounted_cash":161.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 2.6-7.5","code_information":[{"code":"92200011","type":"CDM"},{"code":"981","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":212.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 7.6-12.5","code_information":[{"code":"92200012","type":"CDM"},{"code":"981","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.0,"discounted_cash":262.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 12.6-20.0","code_information":[{"code":"92200013","type":"CDM"},{"code":"981","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":629.0,"discounted_cash":314.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 0-2.5","code_information":[{"code":"92200014","type":"CDM"},{"code":"981","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":399.0,"discounted_cash":199.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 2.6-5.0","code_information":[{"code":"92200015","type":"CDM"},{"code":"981","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":409.0,"discounted_cash":204.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 5.1-7.5","code_information":[{"code":"92200016","type":"CDM"},{"code":"981","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":664.0,"discounted_cash":332.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures 7.6-12.5","code_information":[{"code":"92200017","type":"CDM"},{"code":"981","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.0,"discounted_cash":340.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 0-2.5","code_information":[{"code":"92200019","type":"CDM"},{"code":"981","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":560.0,"discounted_cash":280.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 2.6-7.5","code_information":[{"code":"92200021","type":"CDM"},{"code":"981","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":719.0,"discounted_cash":359.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 7.6-12.5","code_information":[{"code":"92200022","type":"CDM"},{"code":"981","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":753.0,"discounted_cash":376.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 0-2.5","code_information":[{"code":"92200024","type":"CDM"},{"code":"981","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":748.0,"discounted_cash":374.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 2.6-7.5","code_information":[{"code":"92200026","type":"CDM"},{"code":"981","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":763.0,"discounted_cash":381.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 7.6-12.5","code_information":[{"code":"92200027","type":"CDM"},{"code":"981","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":782.0,"discounted_cash":391.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 0-2.5","code_information":[{"code":"92200029","type":"CDM"},{"code":"981","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":412.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Layered 2.6-5.0","code_information":[{"code":"92200030","type":"CDM"},{"code":"981","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":870.0,"discounted_cash":435.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I&D Abscess; Simple Or Single","code_information":[{"code":"92200034","type":"CDM"},{"code":"981","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.0,"discounted_cash":128.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I & D Pilonidal Cyst","code_information":[{"code":"92200037","type":"CDM"},{"code":"981","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":365.0,"discounted_cash":182.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I & D Hematoma Simple","code_information":[{"code":"92200039","type":"CDM"},{"code":"981","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.0,"discounted_cash":152.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Evac Sub Hematoma","code_information":[{"code":"92200041","type":"CDM"},{"code":"981","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.0,"discounted_cash":62.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Avulsion Of Nail","code_information":[{"code":"92200042","type":"CDM"},{"code":"981","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.0,"discounted_cash":120.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Removal Conj Fb","code_information":[{"code":"92200045","type":"CDM"},{"code":"981","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.0,"discounted_cash":60.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Removal Corneal Fb","code_information":[{"code":"92200046","type":"CDM"},{"code":"981","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":80.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Inc And Removal Fb Sq Simple","code_information":[{"code":"92200047","type":"CDM"},{"code":"981","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":395.0,"discounted_cash":197.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Remove Fb Muscle","code_information":[{"code":"92200048","type":"CDM"},{"code":"981","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":807.0,"discounted_cash":403.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Remove Intranasal Fb","code_information":[{"code":"92200049","type":"CDM"},{"code":"981","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.0,"discounted_cash":215.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Remove Fb X Au Canal","code_information":[{"code":"92200050","type":"CDM"},{"code":"981","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.0,"discounted_cash":155.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Burn Initial 1St Deg","code_information":[{"code":"92200051","type":"CDM"},{"code":"981","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.0,"discounted_cash":80.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Burn Dressing W/O Anesth","code_information":[{"code":"92200052","type":"CDM"},{"code":"981","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.0,"discounted_cash":95.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Control Nasal Hemor; Simple","code_information":[{"code":"92200055","type":"CDM"},{"code":"981","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":375.0,"discounted_cash":187.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Reduce Disl-Shoulder","code_information":[{"code":"92200058","type":"CDM"},{"code":"981","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":1664.0,"discounted_cash":832.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Reduce Disl-Patella","code_information":[{"code":"92200059","type":"CDM"},{"code":"981","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1472.0,"discounted_cash":736.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Splint Long Arm","code_information":[{"code":"92200061","type":"CDM"},{"code":"981","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":328.0,"discounted_cash":164.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Splint Short Arm","code_information":[{"code":"92200062","type":"CDM"},{"code":"981","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":312.0,"discounted_cash":156.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Splint Finger","code_information":[{"code":"92200063","type":"CDM"},{"code":"981","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.0,"discounted_cash":138.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Splint Long Leg","code_information":[{"code":"92200064","type":"CDM"},{"code":"981","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":161.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Splint Short Leg","code_information":[{"code":"92200065","type":"CDM"},{"code":"981","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.0,"discounted_cash":167.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Endotracheal Intubat","code_information":[{"code":"92200074","type":"CDM"},{"code":"981","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.0,"discounted_cash":261.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Chest Tube Insertion","code_information":[{"code":"92200077","type":"CDM"},{"code":"981","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.0,"discounted_cash":331.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Lumbar Tap Diagnost","code_information":[{"code":"92200078","type":"CDM"},{"code":"981","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.0,"discounted_cash":196.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Reduce Disl-Finger","code_information":[{"code":"92200081","type":"CDM"},{"code":"981","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":549.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Ecg W/Reading","code_information":[{"code":"92200093","type":"CDM"},{"code":"981","type":"RC"},{"code":"93010","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.0,"discounted_cash":23.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Non-Tun Cath/Central Line 5+","code_information":[{"code":"92206556","type":"CDM"},{"code":"981","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.0,"discounted_cash":421.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I&D Abscess Complex","code_information":[{"code":"92210061","type":"CDM"},{"code":"981","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":534.0,"discounted_cash":267.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Repair Of Nail Bed","code_information":[{"code":"92211760","type":"CDM"},{"code":"981","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":524.0,"discounted_cash":262.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Srep S/N/A/G/Tr/E; 20.1-30.0Cm","code_information":[{"code":"92212006","type":"CDM"},{"code":"981","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.0,"discounted_cash":472.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc C Rep S/A/L; 1.1-2.5Cm","code_information":[{"code":"92213120","type":"CDM"},{"code":"981","type":"RC"},{"code":"13120","type":"HCPCS"}],"standard_charges":[{"gross_charge":984.0,"discounted_cash":492.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Complex 2.6-7.5","code_information":[{"code":"92213132","type":"CDM"},{"code":"981","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":1396.0,"discounted_cash":698.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Complex Ea Addl 5Cm Or Less","code_information":[{"code":"92213133","type":"CDM"},{"code":"981","type":"RC"},{"code":"13133","type":"HCPCS"}],"standard_charges":[{"gross_charge":421.0,"discounted_cash":210.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Arthrocentesis Inj Lg","code_information":[{"code":"92220610","type":"CDM"},{"code":"981","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.0,"discounted_cash":96.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Inj Anesthesia Facial Nerve","code_information":[{"code":"92224402","type":"CDM"},{"code":"981","type":"RC"},{"code":"64999","type":"HCPCS"}],"standard_charges":[{"gross_charge":825.0,"discounted_cash":412.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Closed Tx Elbow","code_information":[{"code":"92224640","type":"CDM"},{"code":"981","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.0,"discounted_cash":145.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Closed Tx Radial Shaft Fracture W/Manipulation","code_information":[{"code":"92225505","type":"CDM"},{"code":"981","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1058.0,"discounted_cash":529.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Treat Fracture Of Ulna","code_information":[{"code":"92225535","type":"CDM"},{"code":"981","type":"RC"},{"code":"25535","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":930.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Closed Tx Distal Rad/Ulna W/Ma","code_information":[{"code":"92225605","type":"CDM"},{"code":"981","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.0,"discounted_cash":930.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Treat Thumb Fracture W/ Manipulation","code_information":[{"code":"92226645","type":"CDM"},{"code":"981","type":"RC"},{"code":"26645","type":"HCPCS"}],"standard_charges":[{"gross_charge":1125.0,"discounted_cash":562.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Reduce Disl Carpometacarpal","code_information":[{"code":"92226670","type":"CDM"},{"code":"981","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":1356.0,"discounted_cash":678.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cl Tx D Phal Fx W/Manip Each","code_information":[{"code":"92226755","type":"CDM"},{"code":"981","type":"RC"},{"code":"26755","type":"HCPCS"}],"standard_charges":[{"gross_charge":1098.0,"discounted_cash":549.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Reduce Disloc-Hip W/O Anes","code_information":[{"code":"92227250","type":"CDM"},{"code":"981","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1265.0,"discounted_cash":632.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cl Tx Tib Shft Fx W Manip","code_information":[{"code":"92227752","type":"CDM"},{"code":"981","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":2384.0,"discounted_cash":1192.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cl Tx Distl Fib Fx W Manip","code_information":[{"code":"92227788","type":"CDM"},{"code":"981","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":1918.0,"discounted_cash":959.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cltx Bimalleolar Ankle Fract W Mnp","code_information":[{"code":"92227810","type":"CDM"},{"code":"981","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":2423.0,"discounted_cash":1211.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cl Tx Trimall Ankle Fx; W Manip","code_information":[{"code":"92227818","type":"CDM"},{"code":"981","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":2323.0,"discounted_cash":1161.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Removal F/B Foot Deep","code_information":[{"code":"92228192","type":"CDM"},{"code":"981","type":"RC"},{"code":"28192","type":"HCPCS"}],"standard_charges":[{"gross_charge":941.0,"discounted_cash":470.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Closed Tx Fx Phal W/Manip","code_information":[{"code":"92228515","type":"CDM"},{"code":"981","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":570.0,"discounted_cash":285.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cl Tx Mtp Jnt Disloc; Wo Anesth","code_information":[{"code":"92228630","type":"CDM"},{"code":"981","type":"RC"},{"code":"28630","type":"HCPCS"}],"standard_charges":[{"gross_charge":307.0,"discounted_cash":153.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cltx Metatarsophlngl Jt Dislc Req Anes","code_information":[{"code":"92228635","type":"CDM"},{"code":"981","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":603.0,"discounted_cash":301.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Control Nasal Hemor; Complex","code_information":[{"code":"92230903","type":"CDM"},{"code":"981","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":578.0,"discounted_cash":289.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Pericardiocentesis","code_information":[{"code":"92233010","type":"CDM"},{"code":"981","type":"RC"},{"code":"33016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1273.0,"discounted_cash":636.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Drainage Of Mouth Lesion","code_information":[{"code":"92240800","type":"CDM"},{"code":"981","type":"RC"},{"code":"40800","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.0,"discounted_cash":166.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Sutures Mouth Tongue 0-2.5","code_information":[{"code":"92241250","type":"CDM"},{"code":"981","type":"RC"},{"code":"41250","type":"HCPCS"}],"standard_charges":[{"gross_charge":426.0,"discounted_cash":213.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Dental Surgery Procedure Unlisted","code_information":[{"code":"92241899","type":"CDM"},{"code":"981","type":"RC"},{"code":"41899","type":"HCPCS"}],"standard_charges":[{"gross_charge":708.0,"discounted_cash":354.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Replace Gtube No Rev Gastrostomy Tract","code_information":[{"code":"92243762","type":"CDM"},{"code":"981","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":523.0,"discounted_cash":261.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I&D Perianal Abscess","code_information":[{"code":"92246050","type":"CDM"},{"code":"981","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":169.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Cath Simple Urethal","code_information":[{"code":"92251702","type":"CDM"},{"code":"981","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.0,"discounted_cash":85.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Penile Injection","code_information":[{"code":"92254235","type":"CDM"},{"code":"981","type":"RC"},{"code":"54235","type":"HCPCS"}],"standard_charges":[{"gross_charge":370.0,"discounted_cash":185.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc I&D Epididymis Tstis&/Scrotal Space","code_information":[{"code":"92254700","type":"CDM"},{"code":"981","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.0,"discounted_cash":278.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Vaginal Delivery Only","code_information":[{"code":"92259409","type":"CDM"},{"code":"981","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":1956.0,"discounted_cash":978.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Inj Anesth; Trigemin Nrv/Bran","code_information":[{"code":"92264400","type":"CDM"},{"code":"981","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.0,"discounted_cash":295.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Digital Block","code_information":[{"code":"92264450","type":"CDM"},{"code":"981","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.0,"discounted_cash":212.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Removal Corneal Fb W/Slit L","code_information":[{"code":"92265222","type":"CDM"},{"code":"981","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.0,"discounted_cash":161.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Remove Impacted Ear Wax Uni","code_information":[{"code":"92269209","type":"CDM"},{"code":"981","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.0,"discounted_cash":34.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Removal Impacted Cerumen W/O A","code_information":[{"code":"92269210","type":"CDM"},{"code":"981","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.0,"discounted_cash":38.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Mod Sed Same Phys/Qhp <5 Yrs Init 15 Min","code_information":[{"code":"92299151","type":"CDM"},{"code":"981","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Mod Sed Same Phys/Qhp 5/>Yrs Init 15 Min","code_information":[{"code":"92299152","type":"CDM"},{"code":"981","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Mod Sed Same Phys/Qhp Ea Add'l 15 Min","code_information":[{"code":"92299153","type":"CDM"},{"code":"981","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.0,"discounted_cash":110.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Critical Care:Init 30-74 Mins","code_information":[{"code":"92299291","type":"CDM"},{"code":"981","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.0,"discounted_cash":441.5,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Hc Critical Care:Ea Adtnl 30 Min","code_information":[{"code":"92299292","type":"CDM"},{"code":"981","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.0,"discounted_cash":186.0,"setting":"both","modifiers":"AQ","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Standard | The modified price is presented in the standard charge value. | Modifier AQ: Physician providing a service in an unlisted health professional shortage area (hpsa)"}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"minimum":16273.58,"maximum":16273.58,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16273.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"minimum":15268.94,"maximum":15268.94,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15268.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"minimum":12034.76,"maximum":12034.76,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12034.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"minimum":9174.0,"maximum":13619.34,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13619.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9174.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"minimum":11450.01,"maximum":19774.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19774.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11450.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"minimum":6613.74,"maximum":31623.18,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10239.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":31623.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10439.35,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6613.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9661.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10439.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"minimum":4202.75,"maximum":14892.83,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":14892.83,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4202.75,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"minimum":1503.97,"maximum":13142.44,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1503.97,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13142.44,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8267.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"minimum":1632.9,"maximum":11256.84,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1632.9,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":11256.84,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5680.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"minimum":8597.05,"maximum":8597.05,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":8597.05,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"minimum":14180.42,"maximum":14180.42,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14180.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"minimum":20233.37,"maximum":20233.37,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20233.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"minimum":2575.45,"maximum":2575.45,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2575.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"minimum":8159.79,"maximum":10431.78,"setting":"inpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":10431.78,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8159.79,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"minimum":1125.10,"maximum":9485.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9310.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":7043.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9485.86,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1125.10,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8342.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"minimum":9652.97,"maximum":9652.97,"setting":"inpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":9652.97,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"minimum":5722.91,"maximum":8769.75,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8769.75,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5722.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"minimum":2771.64,"maximum":2771.64,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2771.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"minimum":16322.41,"maximum":16322.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16322.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"minimum":7057.71,"maximum":7057.71,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7057.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"minimum":51039.82,"maximum":51039.82,"setting":"inpatient","payers_information":[{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":51039.82,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"minimum":7755.66,"maximum":14092.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14092.01,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7755.66,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8671.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"minimum":7606.95,"maximum":13157.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7606.95,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":13157.86,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8939.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"minimum":7022.19,"maximum":15288.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15288.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":15236.60,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14823.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7022.19,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7036.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14708.77,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14978.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11680.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"minimum":1058.49,"maximum":11221.79,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1058.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9989.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11221.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2435.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"minimum":4025.89,"maximum":4025.89,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4025.89,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"minimum":10742.03,"maximum":10742.03,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10742.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"minimum":7677.78,"maximum":7677.78,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7677.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"minimum":1185.89,"maximum":17360.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1185.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":13976.1,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10463.45,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11810.66,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13280.54,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":17360.52,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10376.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7766.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"minimum":4789.21,"maximum":10755.98,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10755.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4789.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8995.13,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10263.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"minimum":8317.02,"maximum":11535.01,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8317.02,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8859.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11535.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"minimum":4608.82,"maximum":27184.78,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12497.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":14609.23,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4666.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12619.48,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10982.63,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8498.65,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":26590.34,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4608.82,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10781.40,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":25436.73,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15884.02,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":27184.78,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5736.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15976.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"minimum":4199.97,"maximum":10110.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8138.60,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":10110.73,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7839.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4199.97,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6205.66,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8037.15,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":8759.77,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"minimum":4700.22,"maximum":4700.22,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4700.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"minimum":1056.67,"maximum":17002.52,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17002.52,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1056.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"minimum":13325.01,"maximum":13325.01,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13325.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"minimum":9936.57,"maximum":30837.70,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":12851.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":30837.70,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9936.57,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9936.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"minimum":12145.49,"maximum":12145.49,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":12145.49,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"minimum":7038.07,"maximum":16694.58,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16314.50,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16072.20,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7038.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16694.58,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"minimum":9305.27,"maximum":19888.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9305.27,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9486.87,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":19888.84,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"minimum":4470.54,"maximum":16586.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7387.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6206.74,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4470.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6307.15,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7516.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16586.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"minimum":14468.6,"maximum":24701.69,"setting":"inpatient","payers_information":[{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24701.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14468.6,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"minimum":6224.14,"maximum":6224.14,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6224.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"minimum":7366.42,"maximum":20051.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12027.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":20051.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11665.79,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10982.38,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10203.18,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7371.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12798.47,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":9762.46,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7366.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9049.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"minimum":10964.76,"maximum":10964.76,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10964.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"minimum":2551.95,"maximum":16126.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16126.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":11048.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15372.50,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2551.95,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"minimum":2359.09,"maximum":9959.24,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9761.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9157.02,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9959.24,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9949.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2359.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"minimum":7303.3,"maximum":7303.3,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7303.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"minimum":8721.7,"maximum":8721.7,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8721.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"minimum":1446.54,"maximum":9327.80,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2119.26,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4569.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7773.17,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9327.80,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1446.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"minimum":14739.29,"maximum":14739.29,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14739.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"minimum":1321.58,"maximum":13536.73,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12097.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1321.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13536.73,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"minimum":1502.19,"maximum":12440.08,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7659.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":8720.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7529.94,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12440.08,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1502.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"minimum":1642.13,"maximum":5918.7,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1642.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2141.55,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1733.81,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5918.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5918.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"minimum":7920.41,"maximum":8982.87,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7920.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8982.87,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8981.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"minimum":11647.83,"maximum":11647.83,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":11647.83,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"minimum":9874.99,"maximum":84733.11,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":84733.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28767.81,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9874.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"minimum":7690.84,"maximum":62003.43,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":62003.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9860.7,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11047.12,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9874.99,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":44557.36,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7690.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"minimum":31687.69,"maximum":31687.69,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":31687.69,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"minimum":23929.1,"maximum":23929.1,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23929.1,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23929.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"minimum":16457.91,"maximum":16457.91,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16457.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"minimum":34780.54,"maximum":34780.54,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":34780.54,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"minimum":28446.84,"maximum":28446.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":28446.84,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"minimum":12313.62,"maximum":12313.62,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12313.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"minimum":17292.52,"maximum":17292.52,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17292.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"minimum":6466.41,"maximum":11256.13,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6466.41,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11256.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"minimum":34323.41,"maximum":34323.41,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":34323.41,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"minimum":16647.49,"maximum":16981.02,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16647.49,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16981.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"minimum":1172.32,"maximum":16613.51,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8787.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":6615.10,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16613.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1172.32,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"minimum":7135.86,"maximum":20780.10,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":20780.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10637.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9296.78,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8762.3,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":7135.86,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"minimum":7519.77,"maximum":16523.4,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":16523.4,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7519.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"minimum":30292.14,"maximum":30292.14,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":30292.14,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"minimum":15137.51,"maximum":15137.51,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15137.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"minimum":5305.69,"maximum":10129.12,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10129.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":9538.37,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9948.86,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5305.69,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10129.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9309.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"minimum":1057.07,"maximum":22704.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6631.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":22704.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1057.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6631.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"minimum":17271.15,"maximum":17271.15,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17271.15,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"minimum":9415.04,"maximum":9415.04,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9415.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"minimum":6968.09,"maximum":9140.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":9140.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6968.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"minimum":5340.62,"maximum":13402.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13402.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5340.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"minimum":7763.16,"maximum":7792.63,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7792.63,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7763.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"minimum":6972.28,"maximum":9634.37,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6972.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9634.37,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"minimum":2059.1,"maximum":21739.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":21739.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2059.1,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11784.79,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9280.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"minimum":2758.75,"maximum":16466.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3440.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10849.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4761.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8069.64,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2758.75,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":11073.13,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6038.79,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13314.91,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9835.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8122.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16466.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"minimum":2307.24,"maximum":14558.09,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2307.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14558.09,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10117.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"minimum":9682.18,"maximum":19800.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":19800.84,"methodology":"percent of total billed charges"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11621.3,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9682.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"minimum":38631.31,"maximum":38631.31,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":38631.31,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"minimum":5585.67,"maximum":14789.27,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14789.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5585.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"minimum":29054.72,"maximum":29054.72,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":29054.72,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"minimum":21252.83,"maximum":21252.83,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21252.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"minimum":33313.42,"maximum":33313.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":33313.42,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"minimum":9450.52,"maximum":9450.52,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9450.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"minimum":34674.6,"maximum":34674.6,"setting":"inpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":34674.6,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"minimum":8767.24,"maximum":38539.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":15749.72,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8767.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38539.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"minimum":26109.94,"maximum":26109.94,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26109.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"minimum":31499.83,"maximum":31499.83,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":31499.83,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"minimum":16446.57,"maximum":16446.57,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16446.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"minimum":4975.95,"maximum":17388.4,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17388.4,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4975.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8412.71,"methodology":"other"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8869.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"minimum":6415.19,"maximum":15976.68,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6415.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15976.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"minimum":1231.56,"maximum":1231.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1231.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"minimum":12636.0,"maximum":20624.62,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20507.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17372.23,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20624.62,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12636.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"minimum":15183.44,"maximum":15183.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15183.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"minimum":17496.55,"maximum":21289.14,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21289.14,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17496.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"minimum":19016.43,"maximum":19016.43,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":19016.43,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"minimum":8578.54,"maximum":8578.54,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":8578.54,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"minimum":17766.68,"maximum":17766.68,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17766.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"minimum":5858.6,"maximum":29447.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5858.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29447.16,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"minimum":21368.5,"maximum":21368.5,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21368.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"minimum":8407.17,"maximum":8407.17,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8407.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"minimum":4291.67,"maximum":7755.75,"setting":"inpatient","payers_information":[{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7755.75,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4291.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"minimum":9825.46,"maximum":9825.46,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9825.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"minimum":8613.49,"maximum":8613.49,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8613.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"minimum":1277.76,"maximum":1277.76,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1277.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"minimum":7358.6,"maximum":8769.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7358.6,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8769.06,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"minimum":6406.08,"maximum":9206.44,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8358.75,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6406.08,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9206.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"minimum":15971.42,"maximum":15971.42,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15971.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"minimum":4265.63,"maximum":8796.61,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4265.63,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8796.61,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"minimum":4994.59,"maximum":4994.59,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4994.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"minimum":14578.48,"maximum":14578.48,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14578.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"minimum":7193.04,"maximum":14415.7,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7193.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14415.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"minimum":1667.71,"maximum":10891.48,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3431.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1667.71,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10891.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4990.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8238.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8999.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"minimum":13653.42,"maximum":13653.42,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13653.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"minimum":8037.88,"maximum":16955.45,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10960.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8037.88,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16955.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"minimum":27375.76,"maximum":27375.76,"setting":"inpatient","payers_information":[{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":27375.76,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"minimum":37263.85,"maximum":37263.85,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37263.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"minimum":3201.95,"maximum":4499.99,"setting":"inpatient","payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3201.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4426.04,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4499.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"minimum":4165.39,"maximum":7611.44,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7611.44,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6206.84,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4295.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4165.39,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"minimum":4757.23,"maximum":8044.42,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4757.23,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8044.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"minimum":8447.78,"maximum":13555.57,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12530.64,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8447.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13555.57,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12626.98,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"minimum":3247.04,"maximum":18780.99,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":18780.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10462.10,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6105.71,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6723.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6568.80,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3247.04,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8080.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"minimum":12557.00,"maximum":12557.00,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":12557.00,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"minimum":8321.9,"maximum":15976.68,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10269.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12869.59,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13102.08,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8321.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15976.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"minimum":1259.41,"maximum":9013.37,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7345.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9013.37,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7452.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6968.61,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8093.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4083.20,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1259.41,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"minimum":5603.77,"maximum":5603.77,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5603.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"minimum":5941.44,"maximum":22391.27,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":22391.27,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5941.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11633.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9300.72,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10490.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12802.11,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"minimum":2651.67,"maximum":14734.69,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8293.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":14734.69,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4894.88,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4686.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7873.1,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":11449.37,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8293.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2651.67,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"minimum":7674.0,"maximum":7674.0,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7674.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"minimum":5122.96,"maximum":14463.35,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12867.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14463.35,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5122.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5908.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13325.01,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"minimum":6308.85,"maximum":10260.01,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10260.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8620.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7843.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6308.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"minimum":10373.39,"maximum":10373.39,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10373.39,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"minimum":37331.00,"maximum":37331.00,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":37331.00,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"minimum":8061.59,"maximum":14712.25,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8061.59,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14712.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"minimum":15852.47,"maximum":15852.47,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15852.47,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"minimum":1305.84,"maximum":1305.84,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"minimum":4203.18,"maximum":20730.06,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":17812.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4703.78,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4203.18,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":20730.06,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10036.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"minimum":11779.49,"maximum":11779.49,"setting":"inpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11779.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"minimum":4873.42,"maximum":4873.42,"setting":"inpatient","payers_information":[{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4873.42,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"minimum":4446.78,"maximum":4446.78,"setting":"inpatient","payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4446.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"minimum":5352.62,"maximum":24864.41,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":24864.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":20832.47,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5352.62,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"minimum":5366.91,"maximum":23569.14,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":23569.14,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5366.91,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8020.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":20298.52,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16804.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"minimum":5036.35,"maximum":18832.93,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":18832.93,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.35,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"minimum":5043.50,"maximum":15612.46,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":13059.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6078.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5043.50,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":15612.46,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"minimum":2545.35,"maximum":19159.11,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":19159.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":16456.01,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8810.63,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5036.35,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2545.35,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5050.64,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":13765.52,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4598.0,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":17944.67,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11384.46,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"minimum":2148.53,"maximum":3935.86,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2148.53,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3935.86,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3896.25,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"minimum":5100.97,"maximum":5100.97,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5100.97,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"minimum":2375.30,"maximum":7331.89,"setting":"inpatient","payers_information":[{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7331.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4278.65,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2375.30,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"minimum":8311.34,"maximum":8311.34,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8311.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"minimum":1093.21,"maximum":5478.96,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4815.70,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5478.96,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2439.48,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3582.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1093.21,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"minimum":1697.98,"maximum":6484.75,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6484.75,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2927.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1705.13,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5850.25,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1697.98,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2015.84,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":2745.78,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1705.13,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2930.77,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3062.65,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3067.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"minimum":1176.13,"maximum":3895.86,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1176.13,"methodology":"percent of total billed charges"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1741.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2843.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1705.13,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3321.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1690.84,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":3568.98,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1327.0,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":2000.87,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3895.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"minimum":4024.15,"maximum":8428.14,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":8428.14,"methodology":"percent of total billed charges"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4024.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":7692.26,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4418.9,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4433.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"minimum":1927.89,"maximum":13934.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":13934.55,"methodology":"percent of total billed charges"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1927.89,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":7832.28,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4426.04,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4418.9,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4418.9,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":9353.14,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":10864.43,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":8803.35,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9104.5,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4433.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"minimum":1942.96,"maximum":11255.32,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6526.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":8844.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4017.6,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4024.74,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":94.2,"estimated_amount":11255.32,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4017.6,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":7869.69,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":8291.07,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":8486.46,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9913.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1942.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"minimum":1055.77,"maximum":1055.77,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1055.77,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"minimum":12952.67,"maximum":13623.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12952.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":13623.68,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"minimum":9144.88,"maximum":16927.55,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9498.12,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":16927.55,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9144.88,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":11118.22,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"minimum":15759.09,"maximum":15759.09,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15759.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"minimum":3788.45,"maximum":4337.89,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4337.89,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3788.45,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"minimum":5425.05,"maximum":5425.05,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5425.05,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"minimum":19131.26,"maximum":19131.26,"setting":"inpatient","payers_information":[{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19131.26,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"minimum":19213.72,"maximum":19213.72,"setting":"inpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19213.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"minimum":18573.93,"maximum":18573.93,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18573.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"minimum":9116.51,"maximum":15032.16,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":15032.16,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9116.51,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"minimum":5291.43,"maximum":28404.95,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18553.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":23716.58,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5291.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16134.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7849.4,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":28404.95,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19906.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6010.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":17148.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"minimum":4730.89,"maximum":16871.68,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":10850.57,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4730.89,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13931.88,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10379.46,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9282.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16871.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"minimum":5308.2,"maximum":5308.2,"setting":"inpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5308.2,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"minimum":6505.34,"maximum":6505.34,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6505.34,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"minimum":4600.87,"maximum":9090.46,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5699.99,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9090.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4600.87,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9090.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"minimum":23233.17,"maximum":29313.69,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":29313.69,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23233.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"minimum":20457.56,"maximum":20457.56,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":20457.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"minimum":11668.29,"maximum":11668.29,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11668.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"minimum":4039.83,"maximum":9114.28,"setting":"inpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9114.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6120.57,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4039.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"minimum":11862.84,"maximum":11862.84,"setting":"inpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11862.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"minimum":13422.35,"maximum":13422.35,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":13422.35,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"minimum":4370.48,"maximum":4370.48,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":4370.48,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"minimum":1861.82,"maximum":7198.08,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":7198.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1861.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"minimum":87396.84,"maximum":87396.84,"setting":"inpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87396.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"minimum":36304.39,"maximum":36304.39,"setting":"inpatient","payers_information":[{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":36304.39,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"minimum":1.00,"maximum":26317.26,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":12361.56,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26317.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","type":"APC"}],"standard_charges":[{"minimum":8.8,"maximum":2210.48,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1315.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1309.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.44,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2210.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":299.73,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1494.66,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate","code_information":[{"code":"0800","type":"APC"}],"standard_charges":[{"minimum":2162.07,"maximum":2162.07,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2162.07,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Synvisc or synvisc-one","code_information":[{"code":"0874","type":"APC"}],"standard_charges":[{"minimum":973.65,"maximum":973.65,"setting":"outpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":973.65,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Euflexxa inj per dose","code_information":[{"code":"0875","type":"APC"}],"standard_charges":[{"minimum":257.42,"maximum":257.42,"setting":"outpatient","payers_information":[{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":257.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"minimum":78.48,"maximum":144.07,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":118.16,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.28,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.45,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.06,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.79,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":116.92,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":120.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.07,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.46,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.79,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.79,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":78.48,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.52,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"minimum":40.0,"maximum":307.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":307.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40.0,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":158.89,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":80.63,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.66,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.38,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.88,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.92,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"minimum":48.01,"maximum":883.10,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":324.9,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.77,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.95,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":309.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":146.6,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.67,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":147.37,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.57,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.48,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":131.30,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.16,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.25,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":531.4,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":158.99,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":774.80,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":152.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":139.82,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":48.01,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":588.04,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":64.19,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.12,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":55.0,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.23,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":883.10,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":450.52,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":405.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":128.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":89.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"minimum":162.79,"maximum":1226.56,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":830.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":274.43,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.68,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":823.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":506.52,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":264.63,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.95,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.07,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.96,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":596.07,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":428.09,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":590.0,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":653.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.95,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.51,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":863.74,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.3,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.67,"methodology":"other"},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":78.9,"estimated_amount":1226.56,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":905.14,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":265.09,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":976.04,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.66,"methodology":"other"},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1137.0,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":962.2,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":793.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":485.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"minimum":326.97,"maximum":8830.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1906.26,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":721.2,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1797.56,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1352.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":642.39,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":527.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":671.38,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.63,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":650.04,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":378.55,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2117.87,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2487.41,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":8830.64,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1371.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":582.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":656.36,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2652.25,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1817.3,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":738.48,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":326.97,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":494.05,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1596.14,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":645.71,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":4058.3,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1878.07,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2061.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":414.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1379.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"minimum":220.4,"maximum":5389.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":3915.53,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1252.29,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":648.82,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3207.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2076.42,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":960.70,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1219.04,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":885.16,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1125.24,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":971.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1062.36,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3180.50,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5199.31,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1024.66,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1066.75,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2714.96,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4975.85,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.06,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.4,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":3310.7,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1246.44,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":4477.85,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1648.82,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5389.27,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3691.7,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1485.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2613.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"minimum":557.22,"maximum":10500.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":10413.49,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1433.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4302.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1652.08,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1601.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":557.22,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2107.35,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1215.75,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1556.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1553.45,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":598.47,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":3076.56,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2429.09,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":10500.17,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5411.72,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1395.91,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2676.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Skin Procedures","code_information":[{"code":"5051","type":"APC"}],"standard_charges":[{"minimum":35.07,"maximum":1405.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":573.04,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":442.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":296.21,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.19,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.49,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":376.72,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":239.39,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":334.78,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":35.07,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1405.03,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":646.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.91,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":179.08,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":431.2,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":359.05,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":477.95,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.23,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":988.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":441.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":340.81,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":230.3,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"minimum":97.46,"maximum":4862.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":830.3,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.11,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":448.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":807.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":97.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":299.20,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":380.25,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":429.27,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.33,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":824.25,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.40,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":734.25,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":341.80,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":750.12,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":393.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4862.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":290.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Skin Procedures","code_information":[{"code":"5053","type":"APC"}],"standard_charges":[{"minimum":283.76,"maximum":1693.60,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1693.60,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":283.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1371.67,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 4 Skin Procedures","code_information":[{"code":"5054","type":"APC"}],"standard_charges":[{"minimum":1928.29,"maximum":5188.93,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5188.93,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1928.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"minimum":50.0,"maximum":6934.20,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1770.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":662.92,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1621.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":50.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":450.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.48,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":500.97,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1064.34,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.41,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1955.38,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.73,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2700.72,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":1841.4,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":384.65,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6934.20,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1104.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"minimum":700.04,"maximum":12288.62,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":4059.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1333.50,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":880.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4771.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1207.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1275.3,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1115.89,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1707.99,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1183.28,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1754.39,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5344.31,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1472.46,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1159.11,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1238.72,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":7017.92,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1600.16,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":700.04,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":12288.62,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1599.63,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3445.42,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7440.47,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"minimum":1517.98,"maximum":11783.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":11783.97,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2533.04,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6945.2,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1517.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1626.46,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2821.91,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1757.34,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2428.81,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":8766.45,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2443.51,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":6832.01,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2821.41,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9924.06,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4832.4,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"minimum":3461.82,"maximum":21155.06,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":21155.06,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4205.64,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":14530.15,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3461.82,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Strapping and Cast Application","code_information":[{"code":"5101","type":"APC"}],"standard_charges":[{"minimum":123.23,"maximum":919.33,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":343.9,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":198.57,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":217.41,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.43,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.33,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.87,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.23,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":919.33,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":252.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Strapping and Cast Application","code_information":[{"code":"5102","type":"APC"}],"standard_charges":[{"minimum":227.0,"maximum":1054.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":262.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":529.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":227.0,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":243.9,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.3,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1054.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Musculoskeletal Procedures","code_information":[{"code":"5111","type":"APC"}],"standard_charges":[{"minimum":170.83,"maximum":3088.64,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":170.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":865.48,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":329.91,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":524.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":193.43,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":683.44,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":842.03,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3088.64,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"minimum":632.69,"maximum":6421.01,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2834.80,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1507.12,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1116.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5105.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":3542.44,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":926.42,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1606.75,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":632.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1360.27,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":6421.01,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1580.81,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5654.16,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3145.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1707.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"minimum":2304.72,"maximum":19807.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":19004.90,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2595.66,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10664.8,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5125.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2429.28,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2304.72,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2636.28,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2417.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7302.72,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16806.22,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":13852.64,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4216.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3161.81,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4615.03,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":15365.13,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":17701.19,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4657.72,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":19807.4,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14601.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6466.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"minimum":741.54,"maximum":39778.78,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":36021.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7904.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":24175.88,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":16301.6,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5911.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7036.08,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5088.01,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5042.41,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11444.22,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4970.86,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13619.11,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30709.12,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":32967.79,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6567.98,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30336.54,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":29464.1,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8557.44,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":26964.29,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7172.70,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":29891.39,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39778.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":741.54,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18324.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"minimum":5209.99,"maximum":73569.06,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":73569.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12668.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":8628.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14117.19,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12832.26,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5209.99,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24922.49,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":40234.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9922.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11461.47,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12352.2,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":55181.43,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12917.77,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38995.25,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26242.14,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"minimum":9562.7,"maximum":100639.90,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24534.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":100639.90,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9562.7,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12359.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15171.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Airway Endoscopy","code_information":[{"code":"5152","type":"APC"}],"standard_charges":[{"minimum":1003.02,"maximum":1003.02,"setting":"outpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1003.02,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"minimum":1208.51,"maximum":5712.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5712.2,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5205.36,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1208.51,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4284.87,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":5080.77,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5431.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2577.97,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"minimum":1820.91,"maximum":6967.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3339.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6967.49,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":6235.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1820.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3150.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3333.52,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2754.94,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2561.81,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5467.39,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5293.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Airway Endoscopy","code_information":[{"code":"5155","type":"APC"}],"standard_charges":[{"minimum":711.76,"maximum":25234.37,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":25234.37,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5812.38,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":22567.4,"methodology":"percent of total billed charges"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":711.76,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":19004.61,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":19914.59,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 ENT Procedures","code_information":[{"code":"5161","type":"APC"}],"standard_charges":[{"minimum":555.54,"maximum":555.54,"setting":"outpatient","payers_information":[{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":555.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 ENT Procedures","code_information":[{"code":"5163","type":"APC"}],"standard_charges":[{"minimum":838.36,"maximum":4414.00,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":4414.00,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2161.61,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1374.50,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1454.3,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1649.39,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":838.36,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3564.54,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2633.02,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":3718.48,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3194.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 ENT Procedures","code_information":[{"code":"5164","type":"APC"}],"standard_charges":[{"minimum":1176.01,"maximum":11847.9,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6967.82,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2424.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5621.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2453.35,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1678.77,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2719.38,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7591.22,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1176.01,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3199.53,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":7479.39,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3198.78,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":11847.9,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":4289.73,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10344.24,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4759.69,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 ENT Procedures","code_information":[{"code":"5165","type":"APC"}],"standard_charges":[{"minimum":1678.77,"maximum":32428.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":32428.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5825.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6908.30,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":21243.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1678.77,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5826.51,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1678.77,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6382.30,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8154.68,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1678.77,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":14278.11,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3235.71,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":4440.25,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7423.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"minimum":544.66,"maximum":1497.15,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1497.15,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":544.66,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"minimum":1146.13,"maximum":7097.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1146.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6453.9,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1536.3,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1637.57,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1822.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1425.43,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":7097.81,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5487.22,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"minimum":1900.97,"maximum":16229.35,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":12478.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3105.60,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1958.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":14607.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":5589.71,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3132.31,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1900.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2542.08,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3027.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16229.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2894.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"minimum":1177.40,"maximum":9861.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2979.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2980.93,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5744.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2844.42,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1177.40,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2847.86,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":6036.14,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3144.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9861.94,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8592.00,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"minimum":3229.15,"maximum":10819.49,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3229.15,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":10819.49,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":9320.11,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":10109.85,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"minimum":7843.65,"maximum":24660.80,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7843.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":24660.80,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11385.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"minimum":18027.83,"maximum":18027.83,"setting":"outpatient","payers_information":[{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":18027.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Blood Product Exchange and Related Services","code_information":[{"code":"5241","type":"APC"}],"standard_charges":[{"minimum":2171.23,"maximum":5588.03,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":3860.18,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2171.23,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2256.02,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5588.03,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"minimum":556.73,"maximum":5005.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5005.32,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":925.36,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":556.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3034.07,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":3245.87,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":913.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":806.8,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1005.54,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1447.71,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":913.13,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":640.02,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3907.72,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3469.81,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":4029.98,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":602.08,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":674.02,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4119.65,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":930.37,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":894.1,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":3369.97,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":806.8,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3922.40,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4057.16,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2562.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"minimum":1152.39,"maximum":7030.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6210.35,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1693.58,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4196.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2322.47,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1504.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1577.31,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1722.41,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1814.55,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.7,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1904.5,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2073.77,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6937.14,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1152.39,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1734.99,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":5289.61,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1397.09,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":4772.51,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1871.91,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":7030.1,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6569.82,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1314.85,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3092.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"minimum":871.56,"maximum":3286.22,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":3286.22,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3058.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2511.36,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.01,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":871.56,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1098.38,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3122.32,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":2730.62,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1136.32,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.01,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2975.57,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":2718.94,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":897.01,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":2711.74,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3003.63,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3019.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1529.29,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"minimum":1000.07,"maximum":5775.87,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":4611.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3708.29,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2465.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1453.72,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1390.68,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1184.14,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1041.78,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1420.5,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3914.74,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3187.91,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3949.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.07,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2228.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":3860.72,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1569.46,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1062.62,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":4306.85,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.07,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":5775.87,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3392.6,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3970.75,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1000.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2074.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"minimum":2219.74,"maximum":19659.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":19659.36,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2219.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3141.51,"methodology":"percent of total billed charges"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2477.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2676.61,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":10692.88,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6440.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"minimum":371.58,"maximum":13874.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":371.58,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3084.23,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10284.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2083.62,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2851.35,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13874.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2367.17,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2699.81,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":11961.77,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3203.46,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10640.43,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8026.19,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"minimum":2979.99,"maximum":28313.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":14585.45,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5745.0,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2979.99,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":12316.22,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":8242.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6084.1,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5353.21,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4861.64,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4316.0,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4737.01,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5699.6,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":22228.64,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":14836.64,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":28313.03,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3603.42,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4108.4,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":13753.05,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3608.41,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":10081.23,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":16570.71,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15715.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4947.38,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7518.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Urology and Related Services","code_information":[{"code":"5372","type":"APC"}],"standard_charges":[{"minimum":633.54,"maximum":1853.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":633.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":639.9,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1853.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Urology and Related Services","code_information":[{"code":"5373","type":"APC"}],"standard_charges":[{"minimum":1572.41,"maximum":7333.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2019.49,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5671.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1572.41,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7333.85,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6169.86,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2024.89,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2020.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3803.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Urology and Related Services","code_information":[{"code":"5374","type":"APC"}],"standard_charges":[{"minimum":2482.24,"maximum":3109.81,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2482.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3051.51,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3109.81,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Urology and Related Services","code_information":[{"code":"5375","type":"APC"}],"standard_charges":[{"minimum":4930.57,"maximum":17345.09,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":17345.09,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4930.57,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8676.13,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Gynecologic Procedures","code_information":[{"code":"5411","type":"APC"}],"standard_charges":[{"minimum":159.05,"maximum":536.70,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":381.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":421.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.44,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":295.01,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.05,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.44,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":202.36,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":392.48,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":536.70,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":379.1,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":425.05,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Gynecologic Procedures","code_information":[{"code":"5414","type":"APC"}],"standard_charges":[{"minimum":1160.50,"maximum":8542.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6555.55,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2803.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6477.96,"methodology":"percent of total billed charges"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2298.32,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3831.74,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1160.50,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8542.8,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1542.00,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":6989.48,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":4449.15,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4941.1,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"minimum":1993.97,"maximum":16876.59,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":10295.08,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":16876.59,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2567.45,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4959.01,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1993.97,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":9725.82,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":12016.66,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":11139.03,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11632.60,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Procedures","code_information":[{"code":"5431","type":"APC"}],"standard_charges":[{"minimum":972.86,"maximum":9886.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":7044.51,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1723.32,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3086.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":972.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1718.47,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1424.12,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1224.71,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.73,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2352.6,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9886.61,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":6495.32,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1480.29,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":5914.59,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1928.48,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":5472.92,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1700.79,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5286.98,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5387.20,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2561.55,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nerve Injections","code_information":[{"code":"5441","type":"APC"}],"standard_charges":[{"minimum":175.38,"maximum":1522.26,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":409.66,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":584.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":175.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.53,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.99,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.89,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.67,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.53,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":196.34,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1522.26,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":305.16,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":522.25,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":242.08,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":539.08,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.99,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":531.56,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.79,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":404.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"minimum":419.68,"maximum":1606.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":660.08,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":622.3,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1182.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1154.95,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":732.93,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":419.68,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":423.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":551.99,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1392.23,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":476.34,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":650.92,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1281.32,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1606.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":702.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nerve Injections","code_information":[{"code":"5443","type":"APC"}],"standard_charges":[{"minimum":708.29,"maximum":4095.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2238.14,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1222.55,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1196.82,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1444.74,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1010.12,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":708.29,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":777.71,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.73,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.73,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4095.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":992.73,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":973.51,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2054.34,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1924.28,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1323.26,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":2073.34,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":880.94,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3179.68,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2480.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1102.71,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"minimum":3030.85,"maximum":3030.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3030.85,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Neurostimulator and Related Procedures","code_information":[{"code":"5462","type":"APC"}],"standard_charges":[{"minimum":5769.59,"maximum":34319.03,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6092.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6588.89,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5769.59,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":34319.03,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13170.07,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"minimum":21105.22,"maximum":55067.45,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21105.22,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":55067.45,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 5 Neurostimulator and Related Procedures","code_information":[{"code":"5465","type":"APC"}],"standard_charges":[{"minimum":30482.05,"maximum":144637.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":144637.17,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30561.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":59279.54,"methodology":"percent of total billed charges"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74822.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30482.05,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":31047.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":63753.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Intraocular Procedures","code_information":[{"code":"5491","type":"APC"}],"standard_charges":[{"minimum":1093.86,"maximum":10328.97,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5824.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2079.81,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5522.90,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1207.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2079.81,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1659.29,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1777.8,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1093.86,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2539.73,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8125.5,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2078.36,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4066.6,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2179.17,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":5697.27,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2221.96,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":6210.28,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10328.97,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2829.36,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Extraocular, Repair, and Plastic Eye Procedures","code_information":[{"code":"5503","type":"APC"}],"standard_charges":[{"minimum":5950.9,"maximum":5950.9,"setting":"outpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5950.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"minimum":65.12,"maximum":365.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":365.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.16,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.44,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":311.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":247.77,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":107.31,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.53,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":81.38,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":75.0,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.45,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.94,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.04,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":66.45,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.9,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":256.40,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":327.85,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":261.63,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":95.69,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.53,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":331.84,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.6,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":85.43,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":319.2,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":150.48,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":86.93,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":312.68,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":82.53,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":245.24,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":313.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":65.12,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":167.27,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"minimum":88.98,"maximum":1586.13,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":585.2,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":100.44,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":556.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":549.3,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.79,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.85,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":88.98,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.84,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.79,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.85,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.69,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.85,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":585.86,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":320.28,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":1586.13,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":514.25,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":136.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.62,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":586.2,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":561.44,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":99.35,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":185.4,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":493.27,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":102.24,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":1241.23,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":548.08,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":570.55,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":268.93,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"minimum":181.13,"maximum":1900.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1244.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":236.6,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1184.24,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1039.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.98,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":221.99,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.67,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":233.67,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.98,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.98,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":267.05,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.42,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1096.3,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":478.04,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":987.02,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":293.00,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":218.09,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":890.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1152.8,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":197.54,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":574.44,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1049.92,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.09,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":1900.63,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1145.83,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1181.62,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":613.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"minimum":309.32,"maximum":2865.11,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2213.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":539.46,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1786.3,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1020.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":493.81,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.32,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":413.51,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":601.24,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2385.49,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1567.16,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1651.41,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":930.0,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1559.39,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":872.06,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":502.37,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1844.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1649.26,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":515.44,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2865.11,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1797.67,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":1185.6,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":539.76,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1818.38,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2058.95,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1303.73,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1011.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"minimum":166.56,"maximum":4516.65,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1111.02,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.29,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2400.87,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":941.97,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":527.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.9,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.78,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":199.78,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":187.66,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.78,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":166.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":947.12,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":240.33,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.72,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":733.6,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":775.33,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":178.16,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":4516.65,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.75,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":994.63,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":947.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":479.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"minimum":177.36,"maximum":2172.58,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2139.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":346.24,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1943.6,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":1850.2,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":442.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":342.28,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.36,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":366.73,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.81,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":352.8,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":404.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":688.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1936.23,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1075.62,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1914.56,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.81,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":289.26,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1621.6,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2068.36,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":345.49,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.04,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1247.50,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":347.02,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":2172.58,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.27,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1689.97,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2124.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.78,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1198.57,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Imaging with Contrast","code_information":[{"code":"5573","type":"APC"}],"standard_charges":[{"minimum":483.33,"maximum":5614.1,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5203.11,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":777.96,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":4122.04,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.64,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":793.19,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":483.33,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.64,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4386.84,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.64,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":707.74,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":3960.34,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":702.84,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":3067.79,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5614.1,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4772.47,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1718.56,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Nuclear Medicine and Related Services","code_information":[{"code":"5591","type":"APC"}],"standard_charges":[{"minimum":316.29,"maximum":1887.92,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1887.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.66,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":375.29,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1528.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":316.29,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":393.31,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.36,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.77,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.77,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1010.02,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1409.98,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.77,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":348.54,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1684.31,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":397.85,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":371.65,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1607.75,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.35,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1811.86,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1836.13,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":810.94,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"minimum":235.59,"maximum":2197.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2187.89,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":530.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1967.11,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.36,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":362.80,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.36,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":481.63,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1621.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":364.36,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.59,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2197.74,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":364.36,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":480.59,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":2001.26,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2041.56,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":560.09,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":989.78,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Nuclear Medicine and Related Services","code_information":[{"code":"5593","type":"APC"}],"standard_charges":[{"minimum":411.96,"maximum":8259.61,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5917.06,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1284.94,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5293.25,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":411.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1167.03,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1265.32,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1027.55,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1167.03,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1572.78,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":8259.61,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3931.95,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1373.79,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1271.35,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6179.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4565.03,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1287.14,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1264.53,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":6050.3,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3564.98,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3037.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"minimum":854.15,"maximum":6076.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6076.2,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1392.42,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1411.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5402.31,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1315.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1392.42,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1234.29,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1369.9,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1364.01,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":854.15,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1342.48,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1116.58,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":5861.7,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1415.25,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":5372.64,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1392.42,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5769.19,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2619.49,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"minimum":104.51,"maximum":420.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":420.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.74,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":402.01,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":130.63,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":104.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":385.85,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.23,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"minimum":329.53,"maximum":3609.6,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2062.79,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":349.43,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1995.84,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1018.09,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":487.08,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":559.2,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":572.22,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":648.25,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3609.6,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":361.64,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1940.64,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":329.53,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":434.17,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":788.45,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":942.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":796.5,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"minimum":811.05,"maximum":17936.14,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":6887.88,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1860.02,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":6044.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1791.7,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1896.37,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1574.11,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1761.16,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":811.05,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":13014.4,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1735.88,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":17936.14,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1867.94,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":5854.69,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2007.79,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5229.41,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":5072.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3340.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"minimum":159.76,"maximum":1182.75,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1182.75,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":207.0,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":781.06,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":159.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.8,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":209.02,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":691.2,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":249.24,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1045.92,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":572.07,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":361.24,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"minimum":419.56,"maximum":2366.84,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1841.1,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.61,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1590.63,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":455.32,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.14,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":419.56,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":455.32,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":548.24,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":2366.84,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":455.32,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1564.85,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1603.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":910.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"minimum":1158.27,"maximum":5177.96,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1676.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5177.96,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1432.08,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1634.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1158.27,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1528.04,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1594.62,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2964.76,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"minimum":42.77,"maximum":867.0,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":490.2,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":222.92,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":42.77,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.32,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.74,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.16,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.46,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":183.48,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":867.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":50.4,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":225.06,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":120.08,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":179.52,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":320.53,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"minimum":90.58,"maximum":2007.05,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":256.19,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":676.18,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2007.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.6,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":123.92,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":206.45,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1553.1,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1489.08,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.6,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":855.82,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.6,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":669.96,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":310.92,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"minimum":162.73,"maximum":3630.93,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1261.98,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1567.3,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":350.07,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":500.14,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":303.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":634.67,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3630.93,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1838.78,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.73,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2253.15,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":335.84,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1044.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":660.88,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Drug Administration","code_information":[{"code":"5691","type":"APC"}],"standard_charges":[{"minimum":1499.16,"maximum":6814.18,"setting":"outpatient","payers_information":[{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1499.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2022.85,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6814.18,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Drug Administration","code_information":[{"code":"5692","type":"APC"}],"standard_charges":[{"minimum":54.57,"maximum":9167.8,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":200.09,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":212.01,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":172.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":383.5,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.63,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":125.45,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.02,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":165.63,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1322.81,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":106.54,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":70.31,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":248.32,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.12,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":168.68,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9167.8,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":118.4,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":485.28,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":489.28,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"minimum":169.98,"maximum":1779.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1075.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":401.33,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":676.35,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":728.4,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.13,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":511.17,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":259.24,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":271.80,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":477.3,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":767.01,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":276.13,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":169.98,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":553.16,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":474.5,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":927.84,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":370.94,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1440.15,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1052.82,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":987.82,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1779.72,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1639.76,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":261.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":486.91,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"minimum":360.26,"maximum":25302.94,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":12309.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10001.27,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1036.91,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":679.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7805.51,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.26,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":662.98,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":448.42,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1299.78,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3341.08,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":10726.79,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1347.20,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":25302.94,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":15532.49,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1633.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":12194.83,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":11906.33,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"minimum":74.12,"maximum":538.27,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":154.06,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":538.27,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.84,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.03,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":153.94,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":523.38,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":134.34,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":74.12,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"minimum":121.94,"maximum":1944.85,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":805.6,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.63,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":309.71,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":732.68,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":588.51,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":263.83,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.38,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":279.36,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":324.22,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":258.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.36,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.94,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":930.84,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1944.85,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.96,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.38,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":857.88,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":306.78,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":974.95,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1033.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":504.68,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"minimum":175.18,"maximum":2148.08,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1620.8,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":430.05,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1573.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":175.18,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.7,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.54,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":749.82,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":1726.4,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.83,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2148.08,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1042.01,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1811.68,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":532.7,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 1 Minor Procedures","code_information":[{"code":"5731","type":"APC"}],"standard_charges":[{"minimum":23.86,"maximum":62.71,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":23.86,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":62.21,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":25.57,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.71,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.86,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Minor Procedures","code_information":[{"code":"5732","type":"APC"}],"standard_charges":[{"minimum":83.59,"maximum":344.63,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":344.63,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.59,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":241.05,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":204.94,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":114.07,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":308.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"minimum":27.51,"maximum":282.2,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":187.15,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.1,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":28.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":159.72,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":172.79,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.51,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.0,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.55,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.48,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.32,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":71.57,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":160.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":226.1,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.0,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":194.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.97,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":58.57,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.8,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":147.86,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.64,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.47,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":92.02,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":131.56,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":56.70,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":206.04,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":282.2,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.51,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":133.48,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"minimum":24.8,"maximum":1057.4,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":600.16,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":121.75,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.91,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":644.54,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":419.34,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":142.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.82,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.82,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":140.36,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":144.59,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.84,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":73.0,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.92,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":380.94,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1057.4,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.62,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.82,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.8,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":749.36,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":148.24,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":637.32,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":833.8,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":126.82,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":627.74,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":510.74,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.58,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":186.9,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Level 2 Electronic Analysis of Devices","code_information":[{"code":"5742","type":"APC"}],"standard_charges":[{"minimum":41.25,"maximum":397.36,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":128.0,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.91,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.39,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":344.43,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":101.4,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.91,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.03,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":96.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.1,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":108.04,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":314.90,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":60.50,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":87.03,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":397.36,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":84.51,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":41.25,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":373.67,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":90.31,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":392.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":343.66,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":146.01,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":177.84,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Cardiac Rehabilitation","code_information":[{"code":"5771","type":"APC"}],"standard_charges":[{"minimum":155.4,"maximum":2352.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":332.5,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":620.9,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":750.33,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1740.2,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":161.88,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1049.89,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":991.1,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":155.4,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":566.58,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":979.94,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":255.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2352.32,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":825.6,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":855.6,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1785.0,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1493.8,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"minimum":360.06,"maximum":5577.94,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5577.94,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":692.34,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":360.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":655.27,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3564.74,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1344.83,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"minimum":156.27,"maximum":1639.97,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1039.67,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":171.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":435.98,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":162.79,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":156.27,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":929.19,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":210.94,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":395.73,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1278.62,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1639.97,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1266.35,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":222.31,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Ventilation Initiation and Management","code_information":[{"code":"5801","type":"APC"}],"standard_charges":[{"minimum":6162.31,"maximum":6162.31,"setting":"outpatient","payers_information":[{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":6162.31,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Ultrasound Composite","code_information":[{"code":"8004","type":"APC"}],"standard_charges":[{"minimum":362.99,"maximum":3651.09,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3651.09,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":362.99,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":901.04,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA without Contrast Composite","code_information":[{"code":"8005","type":"APC"}],"standard_charges":[{"minimum":97.46,"maximum":5295.68,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5295.68,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":665.54,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1524.4,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":97.46,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":223.18,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":567.76,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1463.08,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2472.75,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2508.61,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.57,"methodology":"other"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":217.60,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2293.26,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1691.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1343.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"CT and CTA with Contrast Composite","code_information":[{"code":"8006","type":"APC"}],"standard_charges":[{"minimum":400.64,"maximum":5263.74,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1895.92,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":437.88,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":533.41,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2899.33,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":515.64,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1066.76,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":415.4,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":430.72,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":427.97,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":539.76,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":484.21,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":443.13,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2723.75,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":5263.74,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":3445.74,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":571.92,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":422.07,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":4204.2,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2263.13,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":777.64,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":4402.48,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":400.64,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":5107.72,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":4119.10,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1088.0,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1695.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA without Contrast Composite","code_information":[{"code":"8007","type":"APC"}],"standard_charges":[{"minimum":213.06,"maximum":2741.24,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":2520.65,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":488.78,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1444.50,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":460.46,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":237.56,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":569.53,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":373.72,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":542.41,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":213.06,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2741.24,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":492.28,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1403.3,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2313.22,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1305.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"MRI and MRA with Contrast Composite","code_information":[{"code":"8008","type":"APC"}],"standard_charges":[{"minimum":433.72,"maximum":2890.32,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":672.85,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2890.32,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":433.72,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":651.46,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":565.72,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2753.17,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":760.39,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":2873.29,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2884.63,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1669.17,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Comprehensive Observation Services","code_information":[{"code":"8011","type":"APC"}],"standard_charges":[{"minimum":905.31,"maximum":9430.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":5212.18,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2396.81,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1358.01,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":5844.86,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":2743.78,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1373.73,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2612.42,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2438.22,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1460.68,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3189.86,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2266.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3093.04,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2857.70,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2607.46,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":7667.84,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":9430.72,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2648.43,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":6118.64,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2441.72,"methodology":"other"},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2671.61,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":8106.12,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":6112.81,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":905.31,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":3361.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Rabies vaccine, im","code_information":[{"code":"9139","type":"APC"}],"standard_charges":[{"minimum":38.13,"maximum":595.15,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":595.15,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":391.24,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.13,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":112.54,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, fulphila","code_information":[{"code":"9173","type":"APC"}],"standard_charges":[{"minimum":1663.09,"maximum":3743.03,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":3743.03,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1663.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Injection, udenyca 0.5 mg","code_information":[{"code":"9195","type":"APC"}],"standard_charges":[{"minimum":671.33,"maximum":671.33,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":671.33,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Leuprolide acetate suspnsion","code_information":[{"code":"9217","type":"APC"}],"standard_charges":[{"minimum":441.98,"maximum":9048.72,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":886.17,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":441.98,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":589.04,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":916.72,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":9048.72,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Romiplostim injection","code_information":[{"code":"9245","type":"APC"}],"standard_charges":[{"minimum":656.88,"maximum":5381.9,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":656.88,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":5381.9,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Inj, bupivacaine, nos, 0.5mg","code_information":[{"code":"9290","type":"APC"}],"standard_charges":[{"minimum":1703.72,"maximum":1977.12,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1977.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1703.72,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":1838.22,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Platelets pheresis path redu","code_information":[{"code":"9536","type":"APC"}],"standard_charges":[{"minimum":2506.74,"maximum":2506.74,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2506.74,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"minimum":11.29,"maximum":235.17,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":205.2,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":94.13,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":141.07,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":171.76,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":187.38,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.98,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":122.06,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":97.98,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":150.06,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.0,"methodology":"other"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":229.5,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":127.15,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":216.0,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":11.29,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":83.3,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":213.3,"methodology":"percent of total billed charges"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":150.4,"methodology":"percent of total billed charges"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":172.12,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":235.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":135.09,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"minimum":16.87,"maximum":218.79,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":189.05,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.74,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.69,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":173.66,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":131.17,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":51.65,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":30.78,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":26.87,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":39.32,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":47.54,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":16.87,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":43.58,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":68.79,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":152.95,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.08,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":83.08,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":119.0,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":57.24,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":27.42,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":125.6,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":166.0,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":29.46,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":54.88,"methodology":"other"},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":78.9,"estimated_amount":106.52,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":191.52,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":62.4,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":37.26,"methodology":"other"},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.16,"estimated_amount":74.78,"methodology":"percent of total billed charges"},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":38.12,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":218.79,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":181.17,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":44.32,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":69.96,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"minimum":62.83,"maximum":2060.3,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":905.85,"methodology":"percent of total billed charges"},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":203.37,"methodology":"other"},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":457.5,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":673.12,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":69.4,"estimated_amount":95.83,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":248.37,"methodology":"other"},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":174.29,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":225.17,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":145.9,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":238.41,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":275.12,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Exchange","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":273.01,"methodology":"other"},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":402.56,"methodology":"other"},{"payer_name":"Cigna","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":491.38,"methodology":"other"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":119.40,"methodology":"other"},{"payer_name":"First Health","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":83.0,"estimated_amount":380.97,"methodology":"percent of total billed charges"},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":946.9,"methodology":"percent of total billed charges"},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":298.71,"methodology":"other"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":214.73,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1279.68,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":660.32,"methodology":"percent of total billed charges"},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":164.69,"methodology":"other"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":62.83,"methodology":"other"},{"payer_name":"Paramount","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":79.0,"estimated_amount":1142.82,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Exchange","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":55.0,"estimated_amount":2060.3,"methodology":"percent of total billed charges"},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":351.50,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":1219.14,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":487.44,"methodology":"other"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":545.44,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Other Medicine","code_information":[{"code":"N809","type":"APC"}],"standard_charges":[{"minimum":126.56,"maximum":126.56,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":126.56,"methodology":"percent of total billed charges"}],"billing_class":"facility"}]},{"description":"Observation, Other","code_information":[{"code":"N811","type":"APC"}],"standard_charges":[{"minimum":220.0,"maximum":1677.02,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":1677.02,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":220.0,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":475.99,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"minimum":21.0,"maximum":25.92,"setting":"outpatient","payers_information":[{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":25.92,"methodology":"percent of total billed charges"},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":21.0,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Packaged Services","code_information":[{"code":"N902","type":"APC"}],"standard_charges":[{"minimum":8.08,"maximum":2365.42,"setting":"outpatient","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":95.0,"estimated_amount":1089.7,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":86.4,"estimated_amount":2160.0,"methodology":"percent of total billed charges"},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":451.81,"methodology":"other"},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":24.38,"methodology":"other"},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":1502.86,"methodology":"other"},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":84.01,"estimated_amount":2307.73,"methodology":"percent of total billed charges"},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":281.40,"methodology":"other"},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","additional_payer_notes":"No additional payer notes for this estimated amount.","standard_charge_percentage":85.0,"estimated_amount":8.08,"methodology":"percent of total billed charges"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":2365.42,"methodology":"other"}],"billing_class":"facility"}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"minimum":33.85,"maximum":33.85,"setting":"outpatient","payers_information":[{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm.","standard_charge_algorithm":"Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements.","estimated_amount":33.85,"methodology":"other"}],"billing_class":"facility"}]}],"modifier_information":[{"description":"Bilateral Procedure","code":"50","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Reduced Services","code":"52","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left side (used to identify procedures performed on the left side of the body)","code":"LT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Requirements specified in the medical policy have been met","code":"KX","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy","code":"PS","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing","code":"PI","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit","code":"GY","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"NC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Modifier description not available","code":"VD","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient physical therapy plan of care","code":"GP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient occupational therapy plan of care","code":"GO","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Services delivered under an outpatient speech language pathology plan of care","code":"GN","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Right side (used to identify procedures performed on the right side of the body)","code":"RT","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Preventive Services","code":"33","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Left hand, second digit","code":"F1","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Separate practitioner, a service that is distinct because it was performed by a different practitioner","code":"XP","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]},{"description":"Physician providing a service in an unlisted health professional shortage area (hpsa)","code":"AQ","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Amerihealth Caritas","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Anthem Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Allwell Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Buckeye","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Caresource","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Custom Design Benefit","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Frontpath Health Coalition","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucent Health","plan_name":"Ohio Art All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Medical Mutual","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Ohio Health Choice","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Paramount","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Physicians Health Plan","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Group Ministry Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Maternity Product Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Small Business Aid Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plain Church","plan_name":"Steuben Other Commercial Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Signature Care","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","description":"The modified price is presented in the standard charge value."}]}]}